Lethal cardiotoxicity, steatohepatitis, chronic pancreatitis, and acute enteritis induced by capecitabine and oxaliplatin in a 36-year-old woman

Simona Gurzu,Leonard Azamfirei,Ioan Jung,Zoltan Kadar,Maria Comsulea,Calin Molnar

doi:10.1186/1746-1596-8-150

Simona Gurzu, Leonard Azamfirei + Show 4 more

Open Access

https://doi.org/10.1186/1746-1596-8-150

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Abstract

A 36-year-old female was hospitalized with symptoms suggesting intestinal occlusion. She was diagnosed with adenocarcinoma of the ampulla of Vater (pT4N0 stage) and underwent cephalic duodenopancreatectomy 8 months ago. Five cycles of postoperative chemotherapy were administrated using capecitabine and oxaliplatin (CAPOX or XELOX), the last one being completed 1 month ago. During the present hospitalization, because of normal computed tomography and ultrasound abdominal examination, rehydration and antibiotherapy were administrated. However, 4 days after hospital admission, the patient died. At autopsy and histological examination, we found a severe myocardial sclerosis with large scarring areas, severe steatohepatitis, chronic pancreatitis with large fibrotic areas, and acute enteritis. Alcohol consumption was denied. The patient died due to associated heart, liver and pancreatic failure. This multiorgan toxicity and death following CAPOX regimen had not yet been reported in the literature.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/6472150549833105

Highlights

In advanced gastrointestinal (GI) cancers, an association between cytotoxic drugs and biological agents is usually used
As some clinical trials revealed significant cardiotoxicity in case of intravenous 5-FU, when compared with oral fluoropyrimidine known as capecitabine, and similar or superior efficacy in case of capecitabine, the oral administration of capecitabine is preferred in association with oxaliplatin (XELOX or CAPOX) [2,3,4,5]
We present a multiorgan fatal chemotherapy toxicity, in a 36-year-old female suffering from locally advanced adenocarcinoma of the ampulla of Vater

Summary

Introduction

In advanced gastrointestinal (GI) cancers, an association between cytotoxic drugs and biological agents is usually used. She underwent five chemotherapy cycles with a combined regimen that included oral capecitabine and intravenous oxaliplatin (CAPOX or XELOX). On physical examination, when palpating the abdomen, generalized abdominal tenderness with voluntary guarding was observed, with hypoactive bowel sounds. The abdominal-computed tomography and ultrasound were normal Her serology showed slight anemia (hemoglobin: 10 g/dl, hematocrit: 40%), thrombocytopenia (114,000 platelets/μl), leukocytosis (86.8% neutrophils and 11.5% lymphocytes), and elevated levels of amylase (147 U/L), total bilirubin (6.26 mg/dl), transaminases (aspartate transaminase [AST]: 56 U/L and alanine transaminase [ALT]: 40 U/L), and lactate dehydrogenase (484 U/L). The hepatocytes that were connected to the fibrotic septa were positive at keratin 7 (Figure 1) No vascular changes such as fibrosis of sinusoids and/or veins necrosis of the central hepatocytes were noted. The patient’s age, absence of coronarosclerosis or myocardium hypertrophy, and the associated-hepatic and pancreatic lesions proved that the myocardial disorders had toxic and non-ischemic etiology

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