Severe Myocarditis Caused by XELOX Chemotherapy After Rectal Cancer Surgery: A Case Report
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background Myocarditis is an inflammatory injury of the myocardium triggered by infectious, immune-mediated, and toxic causes. Antineoplastic drug-related cardiotoxicity is increasingly recognized, yet fulminant myocarditis after capecitabine plus oxaliplatin (XELOX) remains rare. Case presentation: We describe a 47-year-old woman with rectal cancer who began adjuvant XELOX 20 days after radical surgery. Eleven days after the first cycle she developed chest pain with diaphoresis, nausea, and vomiting. Electrocardiography showed inferior ST-segment elevation. Emergent coronary angiography revealed no significant stenosis, and viral serology was negative. On hospital day 11 she experienced sustained ventricular tachycardia with hemodynamic instability. Cardiac magnetic resonance imaging demonstrated diffuse myocardial inflammation. Intensive therapy including lidocaine, esmolol, vasoactive agents, direct-current cardioversion, corticosteroids, and intravenous immunoglobulin resulted in full recovery. Conclusions This case underscores the need for vigilance regarding fluoropyrimidine-platinum cardiotoxicity and highlights the diagnostic workup and multidisciplinary management of XELOX-associated myocarditis.
