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Acute hyperammonaemic encephalopathy: case report A 65-year-old man developed acute hyperammonaemic encephalopathy during treatment with capecitabine and oxaliplatin for metastatic atypical lung carcinoid. The man, who was diagnosed with atypical lung cancer of the right superior lobe in 2005, had undergone surgical resection in August 2005. Six years later, he had a local relapse of the disease and multiple metastases. Subsequent liver biopsy confirmed a grade 1 neuroendocrine tumour consistent with metastasis from a lung primary tumour. He had received several treatment until August 2019 due to the disease progression. However, in August 2019, he received radiotherapy because of the appearance of facial bones metastases. On 26 September 2019, he received first cycle of chemotherapy with XELOX regimen comprising capecitabine 1.6 g/m2/day on days 1–15 days, administered every 3 weeks and oxaliplatin 104 mg/m2 on day 1, administered every 3 weeks [routes not stated]. On 07 October 2020, he was hospitalised due to memory impairment, mental confusion and gait disturbance. A head CT scan was unremarkable for cerebrovascular ischaemic events and brain metastases. Blood test revealed hyperammonaemia with ammonia level 167 µmol/L. His transaminases, bilirubin and coagulation test were normal, indicative of a preserved liver function. Electroencephalography and neurological tests confirmed the diagnosis of acute hyperammonaemic encephalopathy. The man was treated with lactulose and unspecified amino acids, and the treatment with capecitabine was discontinued. A rapid recovery was noted within few days. After a week, he was discharged from the hospital. Di Federico A, et al. Hyperammonemic encephalopathy during XELOX regimen. Is it capecitabine or oxaliplatin responsible?. Anti-Cancer Drugs : no pagination, 19 Aug 803502421 2020. Available from: URL: http://doi.org/10.1097/CAD.0000000000000987

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Reactions 26 Sep 2020 No. 1823