A case of neurotoxicity following 5-fluorouracil-based chemotherapy

Abstract

5-Fluorouracil (5-FU) is a commonly used chemotherapeutic agent. However, its neurotoxicity is rare and not well recognized. We report a case of 5-FU neurotoxicity with organic brain syndrome and progression to multifocal leukoencephalopathy in a 44-year-old male patient having malignant gastrointestinal stromal tumor. 5-FU-induced neurotoxicity should, therefore, be considered as an important differential diagnosis in cancer patients with neurological abnormality and history of chemotherapy.

Figure 1.

Abdominal CT shows a large tumor at pelvic cavity

Figure 2.

EEG findings show continuous, diffuse theta and delta with slowing of background activity and poorly regulated posterior dominant rhythm

Figure 3.

Brain magnetic resonance imaging (unenhancing) shows hyperintensive lesions in bilateral cerebellar hemispheres (a1, arrow), thalami and midbrain (a2, arrow) on T2WI without mass effect

Figure 4.

PCR genotyping assay to detect GT to AT mutation. Wide-type DPYP allele gives fragments of 278 and 131 bp bands, whereas the mutant allele gives a unique 409 bp band after Mae II restricition. Lanes 1 and 2 correspond to homozygote mutant and wild-type (patient), respectively. M is 1-kb DNA ladder size markers.