Primary malignant hemangioendothelioma of the liver: survival following nonoperative treatment

Optic neuritis induced by 5-fluorouracil chemotherapy: Case report and review of the literature

Introduction

For over 50 years, 5-Fluorouracil has played a critical role in the treatment of numerous malignancies, including colorectal cancer. Ocular side effects are uncommon and include blurred vision, conjunctivitis, excessive lacrimation and keratitis.

Case report

We report a 57-year-old male with metastatic colorectal cancer who had received extensive chemotherapy with 5-Fluorouracil-based regimens for over 12 months. Following his seventh cycle of cetuximab/FOLFIRI, he developed acute onset global headache, nausea and loss of vision in the right eye. After detailed investigations, including ophthalmologic and neurologic consultations, a diagnosis of optic neuritis was made.

Management and outcome

Chemotherapy was ceased immediately, and intravenous methylprednisolone (1 g) daily for five days was commenced. His headache resolved and vision started to improve within 24 h. Three weeks after completion of corticosteroids, constriction of the right visual field had fully resolved.

Discussion

Atypical optic neuritis is an inflammatory optic neuropathy that can be caused by ischaemia, mechanical compression, nutritional deficiency, toxins and drugs. Drug-induced optic neuritis, while rare, is associated with cytotoxic medications including methotrexate, cisplatin, carboplatin, vincristine and paclitaxel. There have only been five previous case reports implicating 5-Fluorouracil in the development of optic neuropathy. The likelihood of the adverse drug reaction due to 5-Fluorouracil was assessed using the Naranjo algorithm. A score of +7 indicates probable causality. Clinicians should be alert to this potential ocular toxicity in order to initiate prompt cessation of treatment and early ophthalmology referral to prevent visual loss and damage to ocular structures.

Bilateral optic disc oedema and associated optic neuropathy in the setting of FOLFOX chemotherapy

Background

To report a case of bilateral optic disc oedema and associated optic neuropathy in the setting of FOLFOX chemotherapy.

Case presentation

A case of a 57-year-old male being treated with FOLFOX chemotherapy for stage 3B colorectal cancer, who developed bilateral optic disc oedema and associated left sided optic neuropathy is described. The patient presented following cycles 7, 8 and 9 of chemotherapy with a history of bilateral simultaneous intermittent inferior altitudinal field defects. These episodes progressed to bilateral optic nerve oedema and a subsequent left sided optic neuropathy. The patient’s symptoms and oedema regressed with discontinuation of chemotherapy.

Conclusion

This is the first report suggesting a vasospastic role of 5-fluoruracil in 5-FU associated optic neuropathy. It highlights that 5-FU may have the potential to cause arterial vasospasm outside the cardiac vasculature, resulting in end-organ optic nerve ischaemia.

Optic neuropathy in cancer patients. Report of a case possibly related to 5 fluorouracil toxicity and review of the literature

We report the case of a 72-year-old woman suffering from bone metastatic breast cancer and treated with continuous intravenous 5 fluorouracil (5FU) chemotherapy, who presented with a bilateral asymmetric anterior optic neuropathy (ON). A deficiency of dihydropyrimidine dehydrogenase (DPD) was documented. Patients with DPD deficiency are at increased risk for developing unusual and/or severe toxicity to 5FU. We discuss the differential diagnosis of anterior ON and we suggest that 5FU can be responsible for optic nerve toxicity in patients with DPD deficiency.