levoleucovorin and Edema

Posterior reversible encephalopathy syndrome is a clinical and imaging syndrome characterized by endothelial dysfunction, blood-brain barrier disruption, and vasogenic edema. The common clinical symptoms of posterior reversible encephalopathy syndrome include headache, altered consciousness, visual disturbances, and seizures, among which headache and seizures are the most common. The classic imaging patterns usually reveal vasogenic edema.. We describe the case of a middle-aged woman with gastric cancer. She was under treatment by fluorouracil, leucovorin, oxaliplatin, and docetaxel regimen and thrombocytopenia regimen after tumor progression, but developed unconsciousness, irritability, and headache shortly after initiation of treatment. Her magnetic resonance imaging in our hospital shows abnormal signals in bilateral frontal parietal occipital lobes with hyperintensities on T2-weighted magnetic resonance imaging and fluid-attenuated inversion recovery imaging, accompanied by the increased value of apparent diffusion coefficient. And T1-weighted images illustrate hypointense foci, with increased diffusion-weighted imaging signals.. After admission, she was treated to control blood pressure, reduce brain edema, expand blood vessels, improve consciousness, and symptomatic support treatment. 3 days after the onset of the disease, her headache symptoms and state of consciousness gradually improved, and her blood pressure can be controlled at about 130/80 mmHg.. This is the first report that posterior reversible encephalopathy syndrome is caused by a thrombocytopenia regimen, and our case highlights the pathogenic role of a thrombocytopenia regimen in posterior reversible encephalopathy syndrome. However, the association between the thrombocytopenia regimen and previous fluorouracil, leucovorin, oxaliplatin, and docetaxel regimens needs further study.

Topics: Calcium; Cisplatin; Docetaxel; Edema; Female; Fluorouracil; Headache; Humans; Leucovorin; Middle Aged; Oxaliplatin; Posterior Leukoencephalopathy Syndrome; Seizures; Thrombocytopenia

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Drainage; Edema; Fluorouracil; Genital Diseases, Male; Humans; Leucovorin; Lower Extremity; Lymphatic Metastasis; Male; Mobility Limitation; Organoplatinum Compounds; Scrotum

Topics: Anal Canal; Antineoplastic Combined Chemotherapy Protocols; Arterioles; Collagen; Dilatation, Pathologic; Dose-Response Relationship, Radiation; Edema; Endothelium, Vascular; Fibroblasts; Fluorouracil; Humans; Leucovorin; Lymphatic Vessels; Muscle, Smooth; Myofibrils; Organoplatinum Compounds; Perineum; Radiotherapy, Adjuvant; Rectal Neoplasms; Rectum; Tunica Media

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Benzamides; Chromosomes, Human, Pair 22; Chromosomes, Human, Pair 9; Cytarabine; Drug Interactions; Edema; Etoposide; Female; Humans; Imatinib Mesylate; Leucovorin; Methotrexate; Middle Aged; Piperazines; Pleural Effusion, Malignant; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Sodium Potassium Chloride Symporter Inhibitors; Translocation, Genetic

The administration of 5-fluorouracil (FU) and leucovorin (LV) to rats induced a previously unreported sialoadenitis-like toxicity. Four different treatment regimens were used: daily-times-5 iv or ip injections of LV (200 mg/kg) followed 30 minutes later by FU (27.5 mg/kg or 35 mg/kg). These treatments resulted in 3 severity levels of systemic toxicity indicated by changes in body weight. In addition to the well known FU+LV-induced diarrhea, myelosuppression, and stomatitis, facial edema, and enlargement of the submandibular salivary gland were consistently seen. Facial edema occurred almost exclusively in rats that subsequently underwent excessive weight loss and were euthanized. The submandibular, but not parotid or sublingual, salivary gland was enlarged and the severity of this effect changed in a bell-shaped relationship with respect to increasing FU+LV induced loss of body weight. Histologic examination of affected glands established the occurrence of bacterial infection, sialoadenitis and destruction of gland tissue. This paper provides the first known documentation of FU+LV treatment-induced selective pathology of the submandibular salivary gland. The selectivity of this toxicity, apparently not normally seen in humans, to the submandibular salivary gland of the rat is of interest and its mechanism warrants further investigation.

Topics: Animals; Antimetabolites, Antineoplastic; Body Weight; Bone Marrow Cells; Dose-Response Relationship, Drug; Drug Therapy, Combination; Edema; Erythroid Cells; Female; Fluorouracil; Hematocrit; Hemoglobins; Injections, Intraperitoneal; Injections, Intravenous; Leucovorin; Leukocytes; Rats; Rats, Inbred F344; Submandibular Gland