Pub Date : 2022-11-07DOI: 10.33696/casereports.4.015
K. Wang, Jeffrey Chi, M. Saif
Introduction: Imatinib therapy for gastrointestinal stromal tumors (GIST) rarely can cause pigmentary changes. When associated with sensitive areas such as the face, it can cause significant psychosocial impact and efforts should be made to correct it. Here we describe a case of hypopigmentation affecting the face in an African American female with concurrent development of neutropenia with resolution upon dose reduction of imatinib.
{"title":"Imatinib Induced Hypopigmentation and Neutropenia in a Patient with Gastric Gastrointestinal Stromal Tumor","authors":"K. Wang, Jeffrey Chi, M. Saif","doi":"10.33696/casereports.4.015","DOIUrl":"https://doi.org/10.33696/casereports.4.015","url":null,"abstract":"Introduction: Imatinib therapy for gastrointestinal stromal tumors (GIST) rarely can cause pigmentary changes. When associated with sensitive areas such as the face, it can cause significant psychosocial impact and efforts should be made to correct it. Here we describe a case of hypopigmentation affecting the face in an African American female with concurrent development of neutropenia with resolution upon dose reduction of imatinib.","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47665757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-07DOI: 10.33696/casereports.4.018
{"title":"A Challenging Case of Central Nervous System Involvement (CNSi) with Chronic Lymphocytic Leukemia (CLL): A Case Report","authors":"","doi":"10.33696/casereports.4.018","DOIUrl":"https://doi.org/10.33696/casereports.4.018","url":null,"abstract":"","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49615281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-07DOI: 10.33696/casereports.4.016
A. M. Haidary, S. Noor, S. Noor, N. Nasir, Maryam Ahmad, Ramin Saadaat, Ahmad, Shekib Zahier, Haider Ali Malakzai, Abdul Sami Ibrahimkhil
Introduction: Multiple myeloma is a malignant clonal proliferation of immunoglobulin secreting plasma cells in bone marrow. This immunoglobulin produced by neoplastic plasma cells is mostly in the form of a single prominent monoclonal protein. Having two such distinct bands is rarely seen. We present an interesting case with two monoclonal bands on serum protein electrophoresis. Case Report: A middle aged woman presented with skull, vertebral, bilateral femoral lytic lesions. Laboratory investigations revealed elevated serum immunoglobulin G that was both Kappa and lambda light chain restricted on immunofixation electrophoresis (biclonal). The presentation was with aggressive disease, the patient did not respond well with conventional chemotherapy regime, requiring upgrading of chemotherapeutic regime. Conclusion: Biclonal gammopathy in plasma cell dyscrasia can be a product of clonal evolution, thus can be a marker of poor prognosis.
{"title":"Multiple Myeloma with Bi-clonal Gammopathy Presenting with Aggressive Disease: A Case Report","authors":"A. M. Haidary, S. Noor, S. Noor, N. Nasir, Maryam Ahmad, Ramin Saadaat, Ahmad, Shekib Zahier, Haider Ali Malakzai, Abdul Sami Ibrahimkhil","doi":"10.33696/casereports.4.016","DOIUrl":"https://doi.org/10.33696/casereports.4.016","url":null,"abstract":"Introduction: Multiple myeloma is a malignant clonal proliferation of immunoglobulin secreting plasma cells in bone marrow. This immunoglobulin produced by neoplastic plasma cells is mostly in the form of a single prominent monoclonal protein. Having two such distinct bands is rarely seen. We present an interesting case with two monoclonal bands on serum protein electrophoresis. Case Report: A middle aged woman presented with skull, vertebral, bilateral femoral lytic lesions. Laboratory investigations revealed elevated serum immunoglobulin G that was both Kappa and lambda light chain restricted on immunofixation electrophoresis (biclonal). The presentation was with aggressive disease, the patient did not respond well with conventional chemotherapy regime, requiring upgrading of chemotherapeutic regime. Conclusion: Biclonal gammopathy in plasma cell dyscrasia can be a product of clonal evolution, thus can be a marker of poor prognosis.","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45750064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-07DOI: 10.33696/casereports.4.017
{"title":"Right Atrial Metastasis from Melanoma Treated with Immunotherapy","authors":"","doi":"10.33696/casereports.4.017","DOIUrl":"https://doi.org/10.33696/casereports.4.017","url":null,"abstract":"","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43683030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/casereports.3.011
M. Torrez, E. Fischer, Shweta Agarwal
Primary extra cranial meningioma of the ear and temporal bone are exceedingly rare, making up less than 1% of all meningiomas. Histologically, they are indistinguishable from their intracranial counterpart. The histopathologic diagnosis is often challenging, and the differential diagnosis for neoplasms in this unusual location is quite extensive. We report a 64-year-old male patient with history of seizures who presented with coalescing mastoiditis and sigmoid sinus thrombosis. CT and MRI findings were suggestive of a chronic inflammatory process. Operative findings included a flesh-colored mass extending from the mastoid antrum posteriorly towards the Sigmoid sinus. Intraoperative consultation was requested, yielding a diagnosis favoring squamous cell carcinoma, and the decision was made to end the procedure. Additional tissue was submitted for permanent evaluation, and biopsy demonstrated a grade 1 meningioma, supported by morphologic features and immunophenotype. The clinical and histologic findings of the patient are discussed, and we emphasize the challenging nature of this rare entity, particularly with regards to intraoperative analysis. In addition, English literature is reviewed.
{"title":"Primary Temporal Bone Meningioma Presenting as Chronic Mastoiditis and Sigmoid Sinus Thrombosis: Report of a Case with Literature Analysis","authors":"M. Torrez, E. Fischer, Shweta Agarwal","doi":"10.33696/casereports.3.011","DOIUrl":"https://doi.org/10.33696/casereports.3.011","url":null,"abstract":"Primary extra cranial meningioma of the ear and temporal bone are exceedingly rare, making up less than 1% of all meningiomas. Histologically, they are indistinguishable from their intracranial counterpart. The histopathologic diagnosis is often challenging, and the differential diagnosis for neoplasms in this unusual location is quite extensive. We report a 64-year-old male patient with history of seizures who presented with coalescing mastoiditis and sigmoid sinus thrombosis. CT and MRI findings were suggestive of a chronic inflammatory process. Operative findings included a flesh-colored mass extending from the mastoid antrum posteriorly towards the Sigmoid sinus. Intraoperative consultation was requested, yielding a diagnosis favoring squamous cell carcinoma, and the decision was made to end the procedure. Additional tissue was submitted for permanent evaluation, and biopsy demonstrated a grade 1 meningioma, supported by morphologic features and immunophenotype. The clinical and histologic findings of the patient are discussed, and we emphasize the challenging nature of this rare entity, particularly with regards to intraoperative analysis. In addition, English literature is reviewed.","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47718893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/casereports.3.014
Najm Khan, R. Lakshmanan, Snehal Shah, L. Nagarajan
Osmotic Demyelination Syndrome (ODS) is a unique process of selective demyelination and destruction of oligodendrocytes and astrocytes in specific areas of the brain that usually occurs a few days after an osmotic stress [1]. ODS has been described most frequently in association with a rapid correction of hyponatremia, though it may occur with other electrolyte or metabolic abnormalities [1]. ODS is a rather uncommon disorder in childhood [2,3] and encompasses central pontine and extra pontine myelinolysis. ODS may be associated with neurological impairment in the form of ataxia, bulbar dysfunction, gait disturbances, spasticity, seizures, encephalopathy and even coma and death. It may result in long term neurodevelopmental sequelae [2,3].
{"title":"Cortical Visual Impairment (CVI): An Atypical Manifestation of Osmotic Demyelination Syndrome in a Child","authors":"Najm Khan, R. Lakshmanan, Snehal Shah, L. Nagarajan","doi":"10.33696/casereports.3.014","DOIUrl":"https://doi.org/10.33696/casereports.3.014","url":null,"abstract":"Osmotic Demyelination Syndrome (ODS) is a unique process of selective demyelination and destruction of oligodendrocytes and astrocytes in specific areas of the brain that usually occurs a few days after an osmotic stress [1]. ODS has been described most frequently in association with a rapid correction of hyponatremia, though it may occur with other electrolyte or metabolic abnormalities [1]. ODS is a rather uncommon disorder in childhood [2,3] and encompasses central pontine and extra pontine myelinolysis. ODS may be associated with neurological impairment in the form of ataxia, bulbar dysfunction, gait disturbances, spasticity, seizures, encephalopathy and even coma and death. It may result in long term neurodevelopmental sequelae [2,3].","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45534464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/casereports.3.012
A. M. Haidary, R. Azma, S. Noor, Maryam Ahmad
Introduction: Red cell fragmentation may result in erroneously high platelet counts by automated blood counters. Therefore, any abnormal platelet counts in a full blood count analysis should be re-evaluated either using blood film manual counting or with more accurate automated analysis options. Case Report: We report a case of Haemoglobin-H disease that was noted to have a very high platelet count, by newly installed automated blood analyser, during regular follow up. Manual platelet counts and the automated analysis using flowcytometric counting of the same analyser showed a normal platelet count. Conclusion: A wide spectrum of blood disorders can cause pseudothrombocytosis. Whenever an unexpected high platelet count is encountered, alternative modalities should be used to confirm the actual platelet count such as manual count on a blood film. Furthermore, machines using the impedance principle need to be calibrated to reduce the chances of getting abnormal results with actual normal platelet counts.
{"title":"Pseudothrombocytosis Due to Red Blood Cell Fragmentation in Haemoglobin-H Disease","authors":"A. M. Haidary, R. Azma, S. Noor, Maryam Ahmad","doi":"10.33696/casereports.3.012","DOIUrl":"https://doi.org/10.33696/casereports.3.012","url":null,"abstract":"Introduction: Red cell fragmentation may result in erroneously high platelet counts by automated blood counters. Therefore, any abnormal platelet counts in a full blood count analysis should be re-evaluated either using blood film manual counting or with more accurate automated analysis options. Case Report: We report a case of Haemoglobin-H disease that was noted to have a very high platelet count, by newly installed automated blood analyser, during regular follow up. Manual platelet counts and the automated analysis using flowcytometric counting of the same analyser showed a normal platelet count. Conclusion: A wide spectrum of blood disorders can cause pseudothrombocytosis. Whenever an unexpected high platelet count is encountered, alternative modalities should be used to confirm the actual platelet count such as manual count on a blood film. Furthermore, machines using the impedance principle need to be calibrated to reduce the chances of getting abnormal results with actual normal platelet counts.","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46325327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/casereports.3.013
Li Shi, Jie Chen, Jiqing He
Aim: False-negativity of reverse-transcriptase–polymerase-chain-reaction (RT-PCR) for patients with 2019 Novel Coronavirus (COVID-19) via throat swab was discussed. Method: A total of 260 patients were diagnosed with COVID-19 RT-PCR for samples obtained via throat swab. Result: Positive rates of chest Computed tomography (CT) imaging were 96.99% (252/260). Positive rates of RT-PCR were 87.70% for the first time, 92.30% for two times, and 100% for three times. Multiple RT-PCR assay tests resulted in a high positive rate of RTPCR. Combined chest CT scans and RT-PCR lead to a positive rate of 100% even for the first testing, which is conducive to COVID-19 diagnosis. Two patients with COVID-19 were discharged from hospital with false-negative results of RT-PCR using the oropharyngeal swab. There was a significant progression on CT images and an increase in infective markers during their second admission to hospital, which indicated the progressing inflammation. Patients with complete recovery were selected. Symptoms were relieved; dissipation almost completely disappeared on CT image; and infective markers significantly decreased to normal levels, which indicated that the inflammation was not progressing. percent of lymphocyte percent (LYM) increased to normal level. Conclusion: Serial follow-up chest CT scans are quite important for confirming the patients with COVID-19 who resulted negative for RT-PCR of 2019-nCoV nucleic acid. A combination of the RT-PCR test for 2019-nCoV nucleic acid and other detective methods, such as CT imaging are conducive to diagnosis. The roadmap of how to avoid being rehospitalized for patients with COVID-19 was provided. Patients were not allowed to be discharged from hospital even with negative result of RT-PCR of 2019-nCoV nucleic acid.
{"title":"How to Prevent Rehospitalization in Patients with COVID-19","authors":"Li Shi, Jie Chen, Jiqing He","doi":"10.33696/casereports.3.013","DOIUrl":"https://doi.org/10.33696/casereports.3.013","url":null,"abstract":"Aim: False-negativity of reverse-transcriptase–polymerase-chain-reaction (RT-PCR) for patients with 2019 Novel Coronavirus (COVID-19) via throat swab was discussed. Method: A total of 260 patients were diagnosed with COVID-19 RT-PCR for samples obtained via throat swab. Result: Positive rates of chest Computed tomography (CT) imaging were 96.99% (252/260). Positive rates of RT-PCR were 87.70% for the first time, 92.30% for two times, and 100% for three times. Multiple RT-PCR assay tests resulted in a high positive rate of RTPCR. Combined chest CT scans and RT-PCR lead to a positive rate of 100% even for the first testing, which is conducive to COVID-19 diagnosis. Two patients with COVID-19 were discharged from hospital with false-negative results of RT-PCR using the oropharyngeal swab. There was a significant progression on CT images and an increase in infective markers during their second admission to hospital, which indicated the progressing inflammation. Patients with complete recovery were selected. Symptoms were relieved; dissipation almost completely disappeared on CT image; and infective markers significantly decreased to normal levels, which indicated that the inflammation was not progressing. percent of lymphocyte percent (LYM) increased to normal level. Conclusion: Serial follow-up chest CT scans are quite important for confirming the patients with COVID-19 who resulted negative for RT-PCR of 2019-nCoV nucleic acid. A combination of the RT-PCR test for 2019-nCoV nucleic acid and other detective methods, such as CT imaging are conducive to diagnosis. The roadmap of how to avoid being rehospitalized for patients with COVID-19 was provided. Patients were not allowed to be discharged from hospital even with negative result of RT-PCR of 2019-nCoV nucleic acid.","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46421422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.33696/casereports.3.010
Lance M Mabry, D. Peterson, Alicia J. Emerson
The left lateral elbow inferior to the lateral epicondyle had moderate edema and mild ecchymosis. Resisted wrist extension was weak and painful. Large grip and stretching of the wrist extensors reproduced mild pain. The common extensor tendon (CET) and the lateral epicondyle were tender to palpation. Passive accessory motion was positive for hypermobility of the proximal radioulnar joint. Due to concern for an atraumatic CET tear, the physical therapist performed a same-day magnetic resonance imaging (MRI) examination on a 0.25 Tesla Esaote G-Scan Brio.
{"title":"Avulsion of the Common Extensor Tendon and Radial Collateral Ligament Tear","authors":"Lance M Mabry, D. Peterson, Alicia J. Emerson","doi":"10.33696/casereports.3.010","DOIUrl":"https://doi.org/10.33696/casereports.3.010","url":null,"abstract":"The left lateral elbow inferior to the lateral epicondyle had moderate edema and mild ecchymosis. Resisted wrist extension was weak and painful. Large grip and stretching of the wrist extensors reproduced mild pain. The common extensor tendon (CET) and the lateral epicondyle were tender to palpation. Passive accessory motion was positive for hypermobility of the proximal radioulnar joint. Due to concern for an atraumatic CET tear, the physical therapist performed a same-day magnetic resonance imaging (MRI) examination on a 0.25 Tesla Esaote G-Scan Brio.","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44929709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-28DOI: 10.33696/casereports.2.008
M. Ehrlich, Kristin Kaley, M. Smith, M. Saif
Background: Fluoropyrimidines compose the backbone of regimens to treat many common solid tumors, including gastrointestinal (GI), breast and head/neck. As we continue to use these agents routinely, recognition of rare but real toxicities, such as cardiotoxicity, has also improved. The treatment options for patients who have encountered fluoropyrimidine-induced cardiotoxicity are limited as many anti-angiogenic drugs also pose a cardiac risk. Patients and Methods: We present a case series of three patients who developed cardiotoxicity in the form of anginal-like symptoms, EKG changes and elevated cardiac enzymes on infusional 5-FU or capecitabine and were subsequently treated with the s-MOX (simplified-mitomycin-oxaliplatin) regimen for their metastatic colorectal cancer (mCRC). All three patients were tested for polymorphic abnormality of DYPD and TYMS. Results: All three patients were treated with s-MOX consisting of mitomycin-C 7 mg/m2 on day 1 and oxaliplatin 85 mg/m2 on days 1 and 15 (1 cycle = 28 days) after they encountered cardiotoxicity to 5-FU and/or capecitabine. None of these patients developed any cardiotoxicity on s-MOX. Overall, the MOX regimen was well tolerated. The most common toxicities included ≤ 2 grade peripheral neuropathy, nausea, vomiting, thrombocytopenia, and anemia. Grade ≥ 3 toxicities included neutropenia (10%), thrombocytopenia (33%), vomiting (8%), and peripheral neuropathy (30%). DYPD gene was normal in all patients and TYMS was abnormal (2R/2R) in one patient. Conclusion: This is the first case series that reports the safety and feasibility of s-MOX in patients with mCRC who developed cardiac toxicity to 5-FU or capecitabine. The s-MOX regimen may provide an alternative treatment option for patients who either develop fluoropyrimidine-related cardiotoxicity or who have abnormalities in the DYPD gene.
{"title":"Safety and Efficacy of s-MOX Regimen in Patients with Colorectal Cancer Who Developed Cardiotoxicity Following Fluoropyrimidine Administration: A Case Series","authors":"M. Ehrlich, Kristin Kaley, M. Smith, M. Saif","doi":"10.33696/casereports.2.008","DOIUrl":"https://doi.org/10.33696/casereports.2.008","url":null,"abstract":"Background: Fluoropyrimidines compose the backbone of regimens to treat many common solid tumors, including gastrointestinal (GI), breast and head/neck. As we continue to use these agents routinely, recognition of rare but real toxicities, such as cardiotoxicity, has also improved. The treatment options for patients who have encountered fluoropyrimidine-induced cardiotoxicity are limited as many anti-angiogenic drugs also pose a cardiac risk. Patients and Methods: We present a case series of three patients who developed cardiotoxicity in the form of anginal-like symptoms, EKG changes and elevated cardiac enzymes on infusional 5-FU or capecitabine and were subsequently treated with the s-MOX (simplified-mitomycin-oxaliplatin) regimen for their metastatic colorectal cancer (mCRC). All three patients were tested for polymorphic abnormality of DYPD and TYMS. Results: All three patients were treated with s-MOX consisting of mitomycin-C 7 mg/m2 on day 1 and oxaliplatin 85 mg/m2 on days 1 and 15 (1 cycle = 28 days) after they encountered cardiotoxicity to 5-FU and/or capecitabine. None of these patients developed any cardiotoxicity on s-MOX. Overall, the MOX regimen was well tolerated. The most common toxicities included ≤ 2 grade peripheral neuropathy, nausea, vomiting, thrombocytopenia, and anemia. Grade ≥ 3 toxicities included neutropenia (10%), thrombocytopenia (33%), vomiting (8%), and peripheral neuropathy (30%). DYPD gene was normal in all patients and TYMS was abnormal (2R/2R) in one patient. Conclusion: This is the first case series that reports the safety and feasibility of s-MOX in patients with mCRC who developed cardiac toxicity to 5-FU or capecitabine. The s-MOX regimen may provide an alternative treatment option for patients who either develop fluoropyrimidine-related cardiotoxicity or who have abnormalities in the DYPD gene.","PeriodicalId":93075,"journal":{"name":"Archives of medical case reports","volume":"2 1","pages":"23 - 29"},"PeriodicalIF":0.0,"publicationDate":"2020-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45503185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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