Acute hyperammonemic encephalopathy after 5-fluorouracil based chemotherapy

Area of Science:

• Oncology
• Neuroscience
• Pharmacology

Background:

• 5-Fluorouracil (5-FU) is a cornerstone chemotherapy for advanced and metastatic colon cancer.
• While common side effects include gastrointestinal issues and hematologic toxicities, 5-FU-induced encephalopathy is infrequently reported.
• Hyperammonemic encephalopathy is a rare neurotoxicity characterized by altered mental status and elevated ammonia levels without radiological abnormalities.

Observation:

• A colon cancer patient developed confused mental status shortly after receiving Folfox4 chemotherapy (oxaliplatin, folinic acid, and 5-fluorouracil).
• The patient exhibited symptoms consistent with hyperammonemic encephalopathy, including elevated ammonia levels.
• No significant radiological abnormalities were detected in the central nervous system.

Findings:

• This case demonstrates 5-Fluorouracil (5-FU) as a potential cause of hyperammonemic encephalopathy.
• The neurotoxicity manifested as altered mental status in a colon cancer patient post-chemotherapy.
• The findings underscore the need for vigilance regarding rare neurological side effects of 5-FU.

Implications:

• Clinicians should consider hyperammonemic encephalopathy in patients presenting with neurological symptoms after 5-FU chemotherapy.
• Early recognition and management of elevated ammonia levels may be crucial for patient outcomes.
• Further research into the mechanisms and incidence of 5-FU related encephalopathy is warranted.