Cardiotoxicity with 5-fluorouracil (5-FU) therapy has been reported to range from asymptomatic EKG abnormalities to fatal myocardial infarction. We report a prospective study in 100 consecutive patients receiving 5-FU infusion in combination with other chemotherapeutic agents or alone for the treatment of different malignancies with the aim of identifying patients who develop symptomatic cardiotoxicity. Patients with a history of cardiac illness, abnormal EKG or cardiac enzyme levels were excluded. Patients were observed during the total period of infusion, daily EKG was performed on asymptomatic patients, those who developed cardiotoxicity were monitored till symptom-free for 24 h. Eight patients developed symptoms suggestive of cardiotoxicity. Pain was the commonest symptom (5/8), followed by palpitation and sweating. Three patients developed EKG abnormalities and 1 went into cardiogenic shock. Time to toxicity ranged from 18 to 30 h (mean 24 ± 3.7 h) and serial cardiac enzyme levels remained normal in all patients. The symptoms reversed immediately on cessation of the treatment in most of the patients (7/8). Time to recovery ranged from 5 to 60 min (mean 19.28 ± 19.6 min). There was no recorded death due to toxicity. We conclude that 5-Fu infusion is associated with a significant risk of symptomatic cardiotoxicity. Concomitant chemotherapeutic agents, received by all the affected patients, may have a contributory effect too. Cardiotoxicity seems to be completely reversible, particularly in patients without underlying cardiac disease. The patients should be informed about the symptoms and the condition recognised and managed immediately.
5-fluorouracil cardiotoxicity is increasingly recognized with variable presentation. We report a patient who developed cardiogenic shock due to high-dose 5-fluorouracil infusion (1,000 mg/m2 every 24 hr for 96 hr). There was no evidence of myocardial necrosis. The patient recovered completely without any residual cardiac dysfunction. The exact cause of 5-fluorouracil toxicity remains to be determined. The case highlights the need for careful monitoring of patients who receive high-dose 5-fluorouracil for the development of cardiotoxicity.
The lungs are discovered to have been involved by metastasis from extrathoracic tumors in about 30% to 41% of patients at autopsy.1,2 Pulmonary metastasis may mimic primary lung cancer appearing as a single parenchymal lesion and the clinical picture may be indistinguishable from a centrally located bronchogenic carcinoma if the metastasis involves a major bronchus. Such involvement of bronchi by metastatic deposits has been documented by various authors in necropsy series 3,4 or follow-up studies. 5 To highlight the danger of misdiagnosis and consequent inappropriate therapy in such patients, especially if the primary tumor is not evident, we discuss" a rare presentation of renal cell carcinoma (RCC) presenting with pulmonary symptoms more than one year prior to the detection of the primary lesion.
Case ReportA 50-year-old male, first seen elsewhere, presented with a history of cough with expectoration and hemoptysis associated with intermittent fever of six months' duration. He was reported to have chest signs and a radiological picture suggestive of pulmonary tuberculosis. Although he did not have AFB-positive sputum, antitubercular treatment was started empirically (isoniazid, rifampicin and ethambutol). After six months of treatment, in the absence of any response, the treatment was stopped. He was referred to us two months later with a diagnosis of bronchogenic carcinoma, complaining of progressive shortness of breath in addition to the previously recorded symptoms.On admission, he was afebrile, with a pulse rate of 85/min and regular and his BP was 160/90 mmHg. There was no lymphadenopathy or clubbing. Examination of his chest revealed a wheeze which was more prominent on the left side and features of consolidation in the mid-lung field on the left side. The rest of the examination was unremarkable. Blood tests, urine examination and EKG were within normal limits. Sputum examination did not reveal any AFB or malignant cells. Chest x-ray showed a large, irregular, homogenous, hilar opacity extending into the left upper and middle zones and a left paratracheal gland (Figure 1).
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