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

Sep 29, 2026

Gastric adenocarcinoma in older adults often necessitates chemotherapy with 5-fluorouracil (5-FU), which can produce serious adverse effects, including cardiotoxicity and neurological complications. This clinical vignette presents a 73-year-old Ecuadorian woman with controlled hypertension who developed prominent cardiac ischemic/arrhythmic signs and convulsive neurological symptoms within hours after starting 5-FU. Imaging supported 5-FU-related encephalopathy alongside reversible cardiac dysfunction. After withdrawing 5-FU and switching chemotherapy, complete resolution occurred and long-term functional recovery was reported.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Clinical vignette

Patient presentation and initial findings

Cardiac and neurological evaluation

Management and follow-up

© 2025 Greater Poland Cancer Centre. Published by Via Medica. All rights reserved. e-ISSN 2083–4640 ISSN 1507–1367 ISSN: 1507–1367 CLINICAL VIGNETTE Reports of Practical Oncology and Radiotherapy 2025, Volume 30, Number 6, pages: 863–865 DOI: 10.5603/rpor.108579 Submitted: 12.01.2025 Accepted: 12.09.2025 Brain-heart: first case report of simultaneous toxicity of 5-fluorouracil Vladimir Ernesto Ullauri Solórzano 1, Emilio Patricio Abad Herrera 1, 3, Diego Javier Páez Granda 1, Diana Victoria Moreira-Vera 1, 2, Tannia Estefanía Aguirre Soria 2, Liliana Elizabeth Flores Rodríguez 2 1Hospital Metropolitano de Quito, Quito, Pichincha, Ecuador 2Universidad Internacional de Ecuador, Quito, Pichincha, Ecuador 3Universidad de Las Américas, Quito, Pichincha, Ecuador Keywords: cardiomyopathy; cardiotoxicity; neurotoxicity; chemotherapy; 5-fluorouracil Rep Pract Oncol Radiother 2025;30(6):863–865 Gastric adenocarcinoma is a common cancer in older adults, often leading to significant health issues. Chemotherapy, particularly with 5-fluorouracil (5-FU), can cause severe side effects, including cardiotoxicity and neurological complications. Cardiotoxicity may manifest as ischemic heart disease or arrhythmias, especially in patients with pre-existing conditions like hypertension. Neurological effects can include seizures and altered mental status and, while less commonly reported, 5-FU-related encephalopathy is a critical concern. In this context, we present a case ofa 73-year-old Ecuadorian female undergoing chemotherapy for gastric adenocarcinoma who presented with neurological and cardiac symptoms following the initiation of 5-FU. This case highlights the importance of monitoring for adverse effects of chemotherapy, emphasizing the need for timely recognition and management of potential complications to improve patient outcomes. A 73-year-old Ecuadorian female with a history of hypertension controlled with valsartan/hydrochlorothiazide 320/25 mg daily and recently diagnosed with gastric adenocarcinoma. Twelve hours before admission, she started the first dose of chemotherapy based on 5-FU (3600 mg, 46 hours) . She was presented to the emergency department due to a 3-hour history of headache, aphasia, clonic movements, and fluctuating alteration of alertness. This was associated with chest pain rated 10/10, described as oppressive and retrosternal, with radiation to the jaw. A physical examination revealed disorientation in three areas, left upper limb paresis, rated 3/5 on the Daniels scale, and a bilateral Babinski sign was positive. She was hemodynamically stable with ST-segment elevation observed on the lateral side. Initial laboratory results revealed elevated troponins (37.66 ng/L) and 42.84 ng/L at 1 hour. Electrocardiogram at 1 hour with ST-segment correction. Prohormone of brain natriuretic peptide (pro-BNP) at 678 pg/mL. The patient was managed in the intensive care unit for hemodynamic and neurological stabilization. The echocardiogram on admission showed mild apical hypokinesia with decreased STRAIN in that region (Fig. 1A), and the left ventricular ejection fraction (LVEF) was 71% . SCORE2-OP Cardiovascular risk was estimated at 5.8% . GRACE 122 Address for correspondence: Diana Moreira-Vera, Universidad Internacional de Ecuador, Av. Jorge Fernández y Av. Simón Bolívar, 170411, Quito, Ecuador; [e-mail: divimv22@gmail.com](e-mail: divimv22@gmail.com) This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially [https://journals.viamedica.pl/rpor](https://journals.viamedica.pl/rpor) 863 Figure 1. A. Echocardiogram on admission shows mild apical hypokinesia with decreased STRAIN in that region, left ven

FAQs

What symptoms did the patient develop after starting 5-FU?

She presented with headache, aphasia, clonic movements, fluctuating altered alertness, and severe chest pain with ST-segment elevation.

What did cardiac and brain imaging suggest?

Echocardiography showed mild apical hypokinesia with decreased strain and normal LVEF, while brain MRI demonstrated diffusion restriction in the splenium of the corpus callosum consistent with 5-FU-related encephalopathy.

How was the chemotherapy adjusted and what was the outcome?

5-FU was withdrawn and the regimen was switched to paclitaxel plus oxaliplatin. Complete resolution of both cardiac and neurological abnormalities was documented at 4 weeks, with continued secondary prevention and good functional status at one year.

Sep 29, 2026

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