brivudine and Stomatitis

A 66-year-old woman with metastatic mammary carcinoma, who was being treated with capecitabine, contracted a herpes zoster infection that was treated with the antiviral drug brivudin. A drug-drug interaction between brivudin and capecitabine caused medullar aplasia, serious toxic effects to the intestinal mucous membrane, hand-foot syndrome, onycholysis and dental pigmentation.. Physical examination, blood analysis, blood cultures, chest X-ray, bone marrow aspiration and biopsy.. Serious adverse event secondary to inhibition of dihydropyrimidine dehydrogenase by a drug-drug interaction between capecitabine and brivudin.. Intravenous hydration, imipenem, red blood cell and platelet transfusions, filgrastim, omeprazole, care of the mouth and feet, topical anesthetics, systemic analgesics and parenteral nutrition.

Topics: Aged; Anemia, Aplastic; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Breast Neoplasms; Bromodeoxyuridine; Capecitabine; Carcinoma, Ductal, Breast; Combined Modality Therapy; Deoxycytidine; Dihydrouracil Dehydrogenase (NADP); Drug Interactions; Fatal Outcome; Female; Fluorouracil; Herpes Zoster; Humans; Onycholysis; Palliative Care; Peripheral Nervous System Diseases; Salvage Therapy; Stomatitis; Tooth Discoloration