Key result
5-fluorouracil triggers severe chest pain with vasospastic, electrical, and inflammatory pericardial manifestations in one patient.
Why the study?
Fluoropyrimidines can cause cardiotoxicity, most commonly coronary vasospasm and rarely inflammatory pericardial involvement, presenting diagnostic complexity when these manifestations overlap or evolve sequentially.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
5-fluorouracil cardiotoxicity can present with a complex overlap of vasospastic, electrical, and inflammatory pericardial features that resolve with drug discontinuation and colchicine.
BACKGROUND: Fluoropyrimidines are widely used in gastrointestinal malignancies but may produce cardiotoxicity, most commonly coronary vasospasm and rarely inflammatory pericardial involvement. CASE SUMMARY: A 57-year-old man with HER2-positive gastric cancer receiving FOLFOX-6M (leucovorin calcium-FOLinic acid, Fluorouracil and OXaliplatin) plus trastuzumab developed severe chest pain during a 5-fluorouracil (5-FU) infusion. The initial electrocardiogram showed T-wave abnormalities and marked QTc prolongation, whereas cardiac biomarkers remained negative. Echocardiography and coronary computed tomography angiography were normal. Fourteen hours later, new concave ST-segment elevation appeared. Cardiac magnetic resonance demonstrated pericardial hyperintensity and enhancement suggestive of inflammatory involvement, without myocardial necrosis. Symptoms resolved after drug discontinuation and colchicine therapy. DISCUSSION: This case illustrates the diagnostic complexity of 5-FU cardiotoxicity, in which vasospastic, electrical, and possible inflammatory manifestations may overlap or evolve sequentially. TAKE-HOME MESSAGE: 5-FU cardiotoxicity may present late and exhibit multifaceted manifestations and requires a multidisciplinary approach to balance oncologic efficacy with cardiovascular safety.
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Viñas-Mendieta et al. (2026) conducted a case report in HER2-positive gastric cancer (n=1). 5-fluorouracil (5-FU) was evaluated. 5-fluorouracil infusion caused severe chest pain with overlapping vasospastic, electrical, and inflammatory pericardial manifestations in 1 patient with gastric cancer.
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