Brain-heart: first case report of simultaneous toxicity of 5-fluorouracil

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Gastric adenocarcinoma (n=1). Intervention: 5-fluorouracil. Primary outcome: Simultaneous cardiotoxicity and neurotoxicity.

Q: What does this research mean for the field?

5-fluorouracil administration can cause simultaneous acute cardiotoxicity and neurotoxicity that resolves completely following drug withdrawal. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ullauri Solórzano, Vladimir Ernesto; Hospital Metropolitano de Quito, Quito, Pichincha, Ecuador; Abad Herrera, Emilio Patricio; Hospital Metropolitano de Quito, Quito, Pichincha, Ecuador;
Universidad de Las Américas, Quito, Pichincha, Ecuador; Páez Granda, Diego Javier; Hospital Metropolitano de Quito, Quito, Pichincha, Ecuador; Diana Moreira-Vera; Aguirre Soria, Tannia Estefanía; Universidad Internacional de Ecuador, Quito, Pichincha, Ecuador; Flores Rodríguez, Liliana Elizabeth; Universidad Internacional de Ecuador, Quito, Pichincha, Ecuador

doi:10.5603/rpor.108579

December 31, 2025Open Access

Brain-heart: first case report of simultaneous toxicity of 5-fluorouracil

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Key result

5-fluorouracil triggers simultaneous cardiotoxicity and neurotoxicity that fully resolves after drug discontinuation.

n=1

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Why the study?

5-fluorouracil chemotherapy is associated with cardiotoxicity and neurotoxicity, but simultaneous toxicity cases are rare and less well defined.

Key Points

To report a rare clinical case of simultaneous acute cardiotoxicity and neurotoxicity triggered by the initial dose of 5-fluorouracil chemotherapy for gastric adenocarcinoma.
Clinical presentation, laboratory markers, electrocardiography, echocardiography, coronary computed tomography angiography, electroencephalogram, and brain magnetic resonance imaging were evaluated in a 73-year-old female patient.
The patient received emergency intensive care stabilization, pharmacological intervention (oxygen, hydration, antiplatelet, statin, and antiepileptic therapy), and subsequent modification of the chemotherapy regimen.
Within 12 hours of starting 5-fluorouracil (3600 mg), the patient developed 10/10 chest pain with lateral ST-segment elevation, troponin elevation (37.66 ng/L to 42.84 ng/L at 1 hour), pro-BNP of 678 pg/mL, and non-obstructive coronary arteries on computed tomography.
Concurrent neurotoxicity presented as convulsive seizures, fluctuating alertness, left upper limb paresis, and brain MRI showing diffusion restriction in the splenium of the corpus callosum.
Following 5-fluorouracil discontinuation and supportive treatment, complete resolution of both cardiac and neurological pathology occurred at 4 weeks, with the patient remaining functional and asymptomatic at one year.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 73-year-old female with gastric adenocarcinoma who developed simultaneous cardiotoxicity and neurotoxicity following 5-fluorouracil chemotherapy.

I

Intervention

5-fluorouracil (5-FU) 3600 mg over 46 hours

Limitations

Single case report
Dihydropyridine dehydrogenase deficiency testing was unavailable
dihydropyridine dehydrogenase deficiency testing was unavailable

Implication

This case highlights the rare but severe simultaneous occurrence of cardiotoxicity and neurotoxicity following 5-fluorouracil administration, emphasizing the need for prompt recognition and drug withdrawal.

Abstract

Nor required for Clinical Vignette.

Discussion

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Cite This Study

Ecuador et al. (2025) conducted a case report in Gastric adenocarcinoma (n=1). 5-fluorouracil was evaluated on Simultaneous cardiotoxicity and neurotoxicity. 5-fluorouracil administration resulted in simultaneous cardiotoxicity and neurotoxicity, which resolved completely after drug withdrawal.

synapsesocial.com/papers/6aae47640c69660b71ecc6c5 https://doi.org/10.5603/rpor.108579

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Brain-heart: first case report of simultaneous toxicity of 5-fluorouracil

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Brain-heart: first case report of simultaneous toxicity of 5-fluorouracil

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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