Zupancic Mark, Farrajota Neves da Silva Pedro, Kas Elyas Karam, Friesland Signe, Ellingsen Cederö Thomasine, Gerling Marco
Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden.
Case Rep Oncol. 2023 Jul 13;16(1):525-531. doi: 10.1159/000531472. eCollection 2023 Jan-Dec.
Chemotherapy-related encephalopathy is a rare but severe side effect of cancer therapy. Few reports exist on the course of encephalopathy due to 5-fluorouracil (5FU)/carboplatin treatment. Here, we report on a patient in his 70s, who received first-line palliative treatment with carboplatin followed by continuous infusion of 5FU against a metastasized cancer of the base of the tongue. During the first 5FU infusion, the patient developed a coma with sudden onset. In contrast to earlier reports of 5FU-induced encephalopathy, serum ammonium levels were near-normal, despite a slightly increased bilirubin. The electroencephalogram showed signs of general encephalopathy, for which no other probable cause than chemotherapy could be identified. Based on historical reports, the patient's encephalopathy was likely due to 5FU treatment rather than carboplatin. While initially in a coma with a Glasgow Coma Scale score of three, the patient regained consciousness within 3 days of supportive therapy. This case highlights the potentially benign clinical course of 5FU-induced encephalopathy, characterized by fulminant clinical deterioration and quick recovery. Such a rapid deterioration in a palliative setting can pose a clinical dilemma, where invasive treatments such as intubation must be weighed against a limited prognosis, for which this case may provide guidance.
化疗相关性脑病是癌症治疗中一种罕见但严重的副作用。关于5-氟尿嘧啶（5FU）/卡铂治疗所致脑病的病程，相关报道较少。在此，我们报告一例70多岁的患者，其接受了卡铂一线姑息治疗，随后持续输注5FU以治疗舌根部转移性癌。在首次输注5FU期间，患者突然昏迷。与早期关于5FU诱导性脑病的报道不同，尽管胆红素略有升高，但血清铵水平接近正常。脑电图显示有全身性脑病的迹象，除化疗外未发现其他可能病因。根据既往报道，该患者的脑病可能是由5FU治疗而非卡铂引起的。患者最初昏迷，格拉斯哥昏迷量表评分为3分，但在支持治疗3天内恢复了意识。该病例突出了5FU诱导性脑病潜在的良性临床病程，其特点是临床迅速恶化但恢复较快。在姑息治疗中如此迅速的恶化可能会带来临床困境，即必须权衡诸如插管等侵入性治疗与有限的预后，该病例或许能提供指导。
