Antineoplastics/folinic acid
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Deep vein thrombosis, saddle pulmonary embolism and extravasation: case report A 43-year-old man developed deep vein thrombosis (DVT) and saddle pulmonary embolism in the setting of capecitabine, fluorouracil, oxaliplatin and folinic acid, indicated for sigmoid colon cancer. He additionally exhibited extravasation of flurouracil [times to reactions onsets not stated; not all routes stated]. In January 2019, the man was diagnosed with stage IIIB, K-ras (Kirsten rat sarcoma viral oncogene) mutant positive, sigmoid colon cancer. He was on various home medications. He had complaints of rectal bleeding. After cancer diagnosis, he had been initiated on capecitabine 2000 mg/m2/day, split into two doses on day 1 through day 14, and oxaliplatin 130 mg/m2 on day 1 every 21 days for a planned eight cycles. Following two cycles, capecitabine and oxaliplatin combination was discontinued due to intolerance [specific manifestations not stated], and from early April 2019, he was initiated on FOLFOX regimen comprising oxaliplatin, IV fluorouracil [5-fluorouracil] 46h continuous pump infusion and prophylaxis with folinic acid [leucovorin], scheduled for 9 cycles. After administration of cycle three of FOLFOX, he returned to clinic for disconnection of the fluorouracil 46-h continuous pump. The pump was initially disconnected, and it was noted that there was some residual chemotherapy remaining in the pump (13mL or 645mg) and white residue was noted around the port needle. The pump was reconnected and the remaining volume of fluorouracil was infused. Of note, he had no complaints of pain at the port site and left in a stable condition. However, 1-week later, he presented with pain, erythema, and hardness around the port site, and extravasation of fluorouracil could not be ruled out. He developed grade 2 extravasation. The man treated with hydrocortisone and dimethylsulfoxide for the extravasation. In order to verify there were no other issues present, a CT scan with IV contrast was performed, which revealed a saddle pulmonary embolus with evidence of right heart strain. Bilateral lower extremity Doppler ultrasound confirmed a non-occlusive DVT within the left lower extremity spanning from the distal femoral vein to the visualised calf vein levels. Therefore, in May 2019, he underwent a bilateral pulmonary artery thrombolysis following hospitalisation. On 18 May 2019, he was initiated on rivaroxaban. At this time, it was unclear if the DVT was caused by a malfunctioning port or other underlying causes. Also, role of capecitabine, fluorouracil, oxaliplatin and folinic acid towards the formation of DVT and saddle pulmonaryembolism could not be ruled out. FOLFOX regimen was decided to be continued. However, port placement was done in the left subclavian area instead of the right subclavian area to avoid further extravasation. He continued treatment with no further complaints or incidence of venous thromboembolism, or port-related complications. White KE, et al. Saddle pulmonary embolism with fluorouracil: A case report. Journal of O
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