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Fluorouracil Induced Coronary Vasospasm: A Successful Infusion Rechallenge Following Pretreatment Prophylaxis by Jeffrey Joseph Chapa; Anita Turk; Suparna Chandra Clasen is a Medicine article available to read on EtoBox.

What is Fluorouracil Induced Coronary Vasospasm: A Successful Infusion Rechallenge Following Pretreatment Prophylaxis about?

Background: Fluorouracil (5-FU) based chemotherapies are commonly used in regimens to treat solid organ malignancies. However, 5-FU use can cause cardiotoxicity in 1-19% of patients manifesting as chest pain, myocardial infarction, arrhythmia, or even cardiac arrest. Yet, options for non-5-FU related chemotherapies are limited. ## Case: A 35-year-old man with Crohnʼs Disease and colon adenocarcinoma status post colectomy started adjuvant chemotherapy with FOLFOX (oxaliplatin, leucovorin, and continuous 5-FU). On day two of the 5-FU infusion, he developed persistent non-exertional chest pain. EKG noted diffuse ST elevation, high sensitivity troponin-I (hsTrop) peaked at 80 ng/L, and BNP was 133 pg/mL. Echocardiogram (ECHO) revealed normal systolic and diastolic function. Left heart catheterization showed no coronary disease. His 5-FU pump was removed, and he was diagnosed with 5-FU-induced coronary vasospasm. He was treated with isosorbide mononitrate (ISMN), which led to the resolution of symptoms and EKG changes. ## Decision-making: There was concern for recurrent cardiotoxicity, given his dramatic reaction to 5-FU. Considering the limited efficacy of alternative chemotherapy, no

Who reads Fluorouracil Induced Coronary Vasospasm: A Successful Infusion Rechallenge Following Pretreatment Prophylaxis?

Author

Jeffrey Joseph Chapa; Anita Turk; Suparna Chandra Clasen

Publisher

Elsevier BV

Published

2023

Language

EN

Field

Medicine (Health Sciences)