TOXIC CARDIOGENIC-SHOCK IN A PATIENT RECEIVING WEEKLY 24-H INFUSION OF HIGH-DOSE 5-FLUOROURACIL AND LEUCOVORIN

A 54-year-old man was treated with weekly 24-h infusion of high-dose 5 -fluorouracil (2600 mg/m(2)) and leucovorin (100 mg/m(2)) for metastat ic colon cancer. At first, he tolerated the treatment well and no sign ificant toxicity was identified. After a total of eight courses of tre atment, a stable disease was observed, but mild shortness of breath wa s found on occasion. The patient had no previous history of cardiac di sease and the heart performance assessed by left ventricular ejection fraction before treatment was normal. Unfortunately, acute pulmonary e dema with lethal cardiogenic shock occurred during the ninth course of treatment, in spite of intensive medical treatment. The chest X-ray s howed extreme cardiomegaly. Repeated assessment of his heart function by echocardiogram and ventricular ejection fraction revealed a very po or cardiac performance. Toxic cardiogenic shock during weekly 24-h inf usion of high-dose 5-fluorouracil and leucovorin is extremely rare. To the best of our knowledge, no case has been reported in the English l iterature. We report a case and the relevant literature about the inci dence, clinical picture and possible pathophysiology on 5-fluorouracil -related cardioxicity is reviewed.