5-FLUOROURACIL INDUCED GENERALISED TONIC-CLONIC SEIZURES IN COLO-RECTAL CARCINOMA: CASE REPORT
Dr. Joseph Benjamin G. and Sravani Marpaka*
ABSTRACT
The fluorinated pyrimidine 5-Fluorouracil acts as a frontline combination treatment of metastatic colorectal cancer. In advance disease state of cancers the combination chemotherapy regimens such as 5-FU based chemotherapy along with the necessary vitamin caleucovorin and novel cyotoxic agent Oxaliplatin have developed increase in overall survival and disease free state, but at the risk of toxicities. The formation of the intermediary metabolites of 5-FU i.e., fluorocitrate or fluoroactate directly inhibits the krebs tricarboxylic cycle and subsequently affects the destruction of ATP-dependent urea cycle. This results in hyperammonemia causing neurotoxicity such as generalized tonic-clonic seizures. Although neurotoxicity is a rare side-effect of 5-FU, its occurrence may be worrisome and preclude further administration of this vital drug. Here we report on a rare or uncommon adverse drug effect of 5-fluorouracil induced generalized tonic-clonic seizures. A 28 years-old Male patient was diagnosed with advance stage of colo-rectal cancer (CA colon) and was started with combined chemotherapy regimen of (MFOLFOX)6. On second day treatment with 5-FU continuous I.V infusion over 23hours patient experienced drug induced convulsions as generalized tonic-clonic seizures. Treatment was given with anti epileptic drug and I.V fluids and treatment for CA colon was planned with CAPOX later to avoid 5-FU.
Keywords: Colorectal cancer, 5-Flurouracil(5-FU), Neurotoxicity, Genaralised-tonic-clonic seizures, Hyperammonemia.
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