Intermediate dose 5-fluorouracil-induced encephalopathy

Yeon A. Kim, Hyun Cheol Chung, Hye Jin Choi, Sun Young Rha, Jin Sil Seong, Hei Cheul Jeung

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43 Citations (Scopus)


As an acute neurotoxicity, high dose 5-fluorouracil (5-FU)-induced encephalopathy is well-known, but encephalopathy associated with lower dose is rarely reported. Here, we report a case of a male with anal cancer who was treated with 5-FU 1000 mg/m2, continuous infusion for 5 days q4 weeks. At the second and the fourth cycles of chemotherapy, sudden confusion, cognitive dysfunction and disorientation occurred during 5-FU infusion. They were accompanied by hyperammonemia in the absence of focal neurological deficits or structural abnormalities. These symptoms completely disappeared and the serum ammonia level returned to normal after discontinuation of 5-FU and conservative care. In order to investigate a possible deficit of dihydropyrimidine dehydrogenase (DPD), we checked its mRNA level before and after treatment using real-time PCR. The patient's pre-treatment level was 80% compared with reference group, and it was elevated up to 187% of initial after 5-FU treatment, implying that that his encephalopathy may be 5-FU catabolite type rather than DPD deficiency. In conclusion, we report that encephalopathy can develop even with the dose of 5-FU lower than ever reported, and it should be considered as a differential diagnosis for proper management.

Original languageEnglish
Pages (from-to)55-59
Number of pages5
JournalJapanese Journal of Clinical Oncology
Issue number1
Publication statusPublished - 2006 Jan

Bibliographical note

Funding Information:
This study was supported by the Korea Science and Engineering Fund through the Cancer Metastasis Research Center at the Yonsei University.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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