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28 February 2023 : Case report  Indonesia

[In Press] Recurrent Reversible Stroke-Like Encephalopathy After 5-Fluorouracil (5-FU) Chemotherapy: A Case Report and Literature Review

Unusual clinical course, Mistake in diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction , Clinical situation which can not be reproduced for ethical reasons

Kurniawan Agung Yuwono1ABCDEF, Susanna Hilda Hutajulu ORCID logo1ABCD, Abdul Gofir ORCID logo2BD, Dhite Bayu Nugroho34BDEF

DOI: 10.12659/AJCR.938437

Am J Case Rep In Press; DOI: 10.12659/AJCR.938437  

Available online: 2023-02-28, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Chemotherapy based on 5-fluorouracil (5-FU) is a well-established treatment for solid cancers, including metastatic or advanced colon cancer. Despite its efficacy, 5-FU can cause rare but serious adverse events such as acute neurotoxicity, which presents as symptoms similar to stroke.
We report the case of a patient who was diagnosed with stage IV colorectal cancer and who underwent chemotherapy with a high dose of 5-FU as part of the FOLFIRI (Folinic Acid, Fluorouracil, Irinotecan) treatment plan. During the seventh, eighth, and ninth cycles of chemotherapy, the patient suffered from severe encephalopathy, and the cause of this condition was determined to the 46-hour continuous intravenous infusion of 5-FU, which was part of the FOLFIRI regimen.
5-FU-induced hyperammonemic encephalopathy is a rare but serious adverse event that requires immediate recognition and treatment. The first step in managing this condition is to halt the 5-FU infusion and provide the patient with high volumes of fluid. Although most cases of 5-FU-induced encephalopathy resolve spontaneously, recurrence is possible if the drug is re-administered to the same patient. Therefore, it is crucial for healthcare providers to closely monitor patients receiving 5-FU chemotherapy and be aware of the signs and symptoms of hyperammonemic encephalopathy. Early intervention can prevent further complications and ensure the best possible outcome for the patient.
It is important to note that while 5-FU-induced hyperammonemic encephalopathy is rare, it highlights the importance of closely monitoring patients receiving chemotherapy to identify and treat adverse events promptly. This can help improve patient outcomes and prevent serious long-term complications.

Keywords: Colorectal Neoplasms; Ischemic Stroke; IFL Protocol


22 February 2023 : Case report  Taiwan

A 30-Year-Old Woman with an 8-Week History of Anxiety, Depression, Insomnia, and Mild Cognitive Impairment ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938732  

22 February 2023 : Case report  Nigeria

Multidrug-Resistant Kocuria rosea and Methicillin-Resistant Staphylococcus aureus Co-Infection in a Nigeria...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938761  

In Press

17 Mar 2023 : Case report  USA

Dermoid Cyst of the Parotid Gland: Case Report of a Rare Entity and Review of the Literature

Am J Case Rep In Press; DOI: 10.12659/AJCR.939411  

17 Mar 2023 : Case report  Japan

A Case of a Refractory Bleeding Giant Vaginal Wall Cavernous Hemangioma Successfully Managed with Sclerothe...

Am J Case Rep In Press; DOI: 10.12659/AJCR.939474  

16 Mar 2023 : Case report  Indonesia

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938752  

15 Mar 2023 : Case report  USA

Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib F...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938875  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923