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Toxic encephalopathy induced by capecitabine.

B Niemann¹, C Rochlitz, R Herrmann

¹Department of Medical Oncology, Kantonsspital Basel, Basel, Switzerland. bernwardniemann@yahoo.de

|June 26, 2004

Summary

Capecitabine can cause toxic encephalopathy, a rare neurological side effect. This case highlights epilepsy-like symptoms and diffuse white matter changes on MRI, expanding on known 5-fluorouracil toxicity.

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Area of Science:

Neuroscience
Oncology
Radiology

Background:

5-fluorouracil (5-FU) is an antineoplastic agent with known neurotoxic potential.
Toxic encephalopathy is a rare but serious side effect associated with 5-FU chemotherapy.
Typical presentations include cerebellar, neuropsychiatric, and focal neurological deficits with patchy white matter changes on MRI.

Observation:

This report details the first documented case of capecitabine-induced toxic encephalopathy.
The patient presented with symptoms suggestive of epilepsy.
Magnetic resonance imaging revealed diffuse white matter alterations.

Findings:

Capecitabine, a prodrug of 5-FU, can induce toxic encephalopathy.
The observed neurological symptoms included epilepsy-like manifestations.

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Imaging findings demonstrated diffuse, rather than patchy, white matter alterations.

Implications:

This case expands the spectrum of known neurotoxic effects of fluoropyrimidine chemotherapy.
It underscores the importance of considering capecitabine in the differential diagnosis of toxic encephalopathy, especially with atypical MRI findings.
Further research is warranted to elucidate the mechanisms and prevalence of capecitabine-induced neurotoxicity.