Acute Gout Flare After Carboplatin/5-Fluorouracil for Locally Advanced Head and Neck Squamous Cell Carcinoma

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer globally. For locally advanced cases when upfront surgery or radiation are not feasible, a platinum agent (carboplatin or cisplatin) with 5-fluorouracil (carbo-5FU) and immunotherapy is the standard of care. We present the first documented case of acute gout flare in a HNSCC patient after initiation of carboplatin-5-fluorouracil.

A 67-year-old male patient with a remote history of gout and recurrent HPV-associated oropharyngeal squamous cell carcinoma (OSCC) presented for evaluation and management of local recurrence. He underwent right tonsillectomy, chemoradiation, and naturopathic therapy over the past 9 years, but the OSCC recurred in the right neck. As the patient was deemed a poor surgical candidate and declined radiation therapy, he was counseled on treatment options and elected to proceed with palliative systemic carbo-5FU therapy but experienced an acute gout flare after cycle 1. Uric acid was checked and found to be elevated at 9.3. He then started prednisone, allopurinol, and intravenous hydration for gout control, and his initially elevated uric acid levels normalized over the next 5 weeks.

Our case describes the first documented incidence of gout flare precipitated by carbo-5FU, but also demonstrates a successful pharmacological treatment approach to control chemotherapy-induced gout.