Abstract Background The combination of bleomycin, etoposide, and cisplatin is the standard regimen for good-risk metastatic nonseminomatous germ cell tumors, with etoposide and cisplatin used when pulmonary risk is present. Etoposide and cisplatin therapy is generally well tolerated, and severe toxicities are particularly rare after the first standard-dose cycle. We report a case of early-onset, simultaneous multiorgan failure after a single cycle of etoposide and cisplatin therapy, successfully managed with etoposide–carboplatin. Case presentation A 54-year-old Japanese man with stage IIa nonseminomatous germ cell tumor received a standard-dose first cycle of etoposide and cisplatin therapy (etoposide 100 mg/m 2 , cisplatin 20 mg/m 2 , days 1–5). Despite appropriate hydration, he developed hepatic dysfunction, severe diarrhea, ototoxicity, acute kidney injury requiring hemodialysis, pancytopenia, and visual impairment. Supportive therapy, including dialysis, corticosteroids, broad-spectrum antibiotics, and granulocyte colony-stimulating factor, was provided. Although renal function partially improved, the patient had persistent severe renal dysfunction consistent with Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury, rendering further cisplatin therapy unsafe. He subsequently received three cycles of etoposide–carboplatin (etoposide 100 mg/m 2 , days 1–5; carboplatin area under the curve 5), which were well tolerated. Tumor markers normalized, and imaging confirmed complete remission. At 12-month follow-up, he remained disease-free with stable renal function and improved general condition. Conclusion This case demonstrates that even a standard-dose, first-cycle etoposide and cisplatin regimen can trigger abrupt, life-threatening multiorgan toxicities affecting renal, hepatic, auditory, hematologic, and visual systems. Such early, simultaneous onset has rarely been described in scientific literature. When cisplatin continuation is unsafe, etoposide–carboplatin may serve as a feasible alternative to achieve remission while minimizing systemic toxicity. Careful evaluation of patient-specific risk factors, including hypertension, renal reserve, and renin–angiotensin system inhibitor use, is essential before initiating cisplatin-based therapy. This case highlights the importance of individualized treatment planning and prompt recognition of severe chemotherapy-induced toxicities.
Mochizuki et al. (Wed,) studied this question.