A 30 year old male patient presented with history of fever since three weeks associated with joint pain, altered sensorium and vomiting. The patient was diagnosed with malaria-Plasmodium falciparum. He was started on Artesunate for seven days along with broad spectrum antibiotics. He was conscious but not oriented. Later he had a sudden onset of respiratory distress and was intubated. Systemic evaluation showed the following: a. Heart rate: 80b/min b. Blood pressure: 140/70 mmHg c. SPO 2 : 100% on mechanical ventilation d. Respiratory rate: 18/min Examination of the respiratory system showed bilateral ronchi with scattered minimal crepitations. A CT chest was done indicating right pneumothorax. CNS examination showed a Glasgow Coma Scale of E2VTM2. Human Immunodeficiency Virus (HIV) screening test was positive and henceforth confirmatory test (MGIT, MTB PCR, ELISA-HIV) were done which reported as negative. In addition, the possibility of Pneumocystis carinii, yeast and Filamentous fungi were also ruled out. Other systemic examinations were within normal limits. CT of brain showed features suggestive of cerebral malaria. Lymphocyte values as shown in the table below were predominantly below normal or just above the normal lower limit. Platelet levels were gradually increasing and esinophils were above the upper limit and was fluctuating.
Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, complication. Cardiac toxicity of 5FU include acute coronary syndrome (ACS), cardiomyopathy, vasospastic angina, coronary thrombosis and dissection, malignant arrhythmias, and sudden cardiac death.With shorter bolus regimens, the incidence of cardiotoxicity typically lies between 1.6% to 3% of cases and with more prolonged regimens, these percentages increase to 7.6% to 18%. We intend to share four cases which showed cardiac toxicity on chemotherapy with 5FU. All our patients were getting continuous infusion regimens. 2 patients had arrhythmias one SVT and one bradycardia), one had reversible cardiomyopathy and one had acute coronary vasospam. 2 patients were suffering from carcinoma esophagus and one from carcinoma nasopharynx and another from cholangiocarcinoma. All were not having any cardiac risk factors. In all our cases the event was completely reversible. Except in the patient who had cardiomyopathy, chemotherapy was continued without any further issues.Here we Concluded With increased usage of 5-FU for the treatment of gastrointestinal malignancies, cardiotoxicities may be expected to be encountered more frequently in the future. A pre-chemotherapy history, physical examination and a basic cardiac evaluation and monitoring in high risk cases might be able to prevent such events ABS056
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