Simultaneous peripheral facial palsies (SPFP) and bilateral foot drops after initiation of eribulin in a patient with triple-negative breast cancer.

Abstract

e11085 Background: Simultaneous peripheral facial palsy (SPFP) is extremely rare. Unlike Bell’s palsy it is seldom idiopathic. We describe a case of acute SPFP and bilateral foot drops attributed to the novel chemotherapeutic agent, eribulin mesylate (EM), a synthetic microtubule inhibitor. Methods: Utilizing the medical record as well as physical evaluation and assessment, we diagnosed SPFP and bilateral foot drops temporally related to administration of EM for metastatic triple negative (ER neg/PR neg/HER2 neg) breast cancer. Results: A 71-year-old woman initially diagnosed with Stage I, T1N0M0, ER neg/PR neg/HER2 neg invasive ductal carcinoma of the left breast treated with adjuvant radiotherapy recurred 3 years later with liver metastases. Salvage treatment included first-line capecitabine for 6 months followed by paclitaxel for 13 months with residual grade 1 peripheral neuropathy. Fourteen days following last paclitaxel dosing, EM was started. Within 3 weeks of initiation of therapy, the patient presented with bilateral SPFP, as well as bilateral complete foot drops. She was unable to speak or take liquid or solid oral intake and unable to bear weight. Extensive work-up including initial CT of the brain, followed by MRI and LP revealed no metastatic or infectious (i.e. – Lyme disease, ACE, TSH, ANA, SPEP) etiology. After discontinuation of EM, physical and speech therapy were instituted including in-patient rehab. After follow-up of 16 weeks, she has partial resolution of the facial palsy and improved ambulation with bilateral foot braces and walking cane. Conclusions: Unlike unilateral Bell’s palsy, the differential diagnosis for SPFP includes many conditions that can potentially turn fatal within a short period of time if they are not diagnosed and treated promptly. To the best of our knowledge, CIN presenting with SPFP or foot drop due to EM has not been reported. We highlight the need to screen patients for pre-existing neuropathy and continued close monitoring for development of neuropathy to avoid potentially dose-limiting disabilities before initiating eribulin.