Capecitabine-induced acute toxic leukoencephalopathy.

Area of Science:

• Neuro-oncology
• Radiology
• Oncology

Background:

• Capecitabine is an oral prodrug of 5-fluorouracil (5-FU) widely used for various cancers, including breast cancer.
• Chemotherapy-induced neurotoxicity is a significant concern, with leukoencephalopathy being a rare but serious adverse effect.
• While 5-FU and other derivatives are known to cause leukoencephalopathy, cases associated with capecitabine are less frequently reported.

Observation:

• A 45-year-old woman with metastatic breast cancer developed neurological symptoms including nausea, headache, muscle cramps, dysarthria, and dysphagia during capecitabine treatment.
• Initial brain CT was normal, but MRI revealed bilateral, symmetric white matter lesions characteristic of acute leukoencephalopathy, similar to 5-FU toxicity.
• Symptoms resolved upon discontinuation of capecitabine, indicating a direct link between the drug and the neurological presentation.

Findings:

• The case highlights acute toxic leukoencephalopathy as a potential adverse effect of capecitabine, presenting with pseudo-stroke symptoms.
• MRI, particularly diffusion-weighted imaging and FLAIR sequences, is critical for diagnosing chemotherapy-induced leukoencephalopathy.
• Discontinuation of capecitabine led to a significant regression of neurological symptoms.

Implications:

• This case underscores the importance of recognizing capecitabine-induced leukoencephalopathy, even though it is less common than with other 5-FU agents.
• Early diagnosis through neuroimaging and prompt cessation of chemotherapy can lead to reversible neurological deficits.
• Oncologists and radiologists should consider capecitabine as a potential cause of leukoencephalopathy in patients presenting with relevant neurological symptoms.