5-flurouracil (5-FU) is a frequently administered chemotherapeutic drug in various malignant neoplasms. We report four cases of cancer patients who were exposed to 5-FU and which resulted in cardio toxicity. Patients developed supraventricular tachycardia, sinus bradycardia, cardiomyopathy, and acute coronary vasospasms. In all cases, the events were reversible. Except in case of cardiomyopathy the chemotherapy was continued without any further issues. All the observed adverse drug reactions (ADR) were carefully studied and the causality was assessed using Naranjo ADR probability scale.
Hepatitis is mostly occurred by alcohol, drugs, or virus. Herpes simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures, but it is a fatal complication. Pregnant women are more vulnerable as the immunological changes during pregnancy suppress T-cell-mediated immunity promoting disseminated infection. Although HSV-associated hepatic failure carries a high-mortality risk, early intervention with acyclovir may prove to be life-saving. Here in, we report a case of 22-year-old female 8 weeks primigravida admitted with complaints of yellowish discoloration of eyes and urine and was provisionally diagnosed to have acute severe hepatitis with no hepatic encephalopathy or liver failure. Immunoglobulin M HSV test was positive, suggestive of HSV-induced hepatitis. Due to severe hepatic failure, living donor liver transplantation (left lobe with middle hepatic vein) was performed. She was treated with antivirals, immunosuppressants, and other conservative treatments. After few days her general condition was good, and laboratory investigations were stable. She was shifted out from intensive care unit. At the time of discharge, she was comfortable, vitals stable and wound was healthy. It should be considered in the differential diagnosis of any case of severe hepatitis with concomitant fever, abdominal pain, and elevated values of liver function tests with or without jaundice. The administration of intravenous acyclovir is inexpensive, without drug interactions, and safe even during pregnancy. Clinicians should be aware of HSV-induced hepatitis in immunocompromised patients and its risk factors.
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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