A case of a tongue cancer associated with hyperammonemia caused by 5-fluorouracil

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  • 5-FUに起因した高アンモニア血症をきたした舌癌の1例
  • 5-FU ニ キイン シタ コウアンモニア ケツショウ オ キタシタ ゼツガン ノ 1レイ

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Abstract

We describe a patient with tongue cancer who had hyperammonemia with impaired consciousness possibly caused by 5-fluorouracil (5-FU). <br>The patient, a 72-year-old-man, was given a diagnosis of tongue squamous cell carcinoma (T4N2cM0). He underwent subtotal tongue resection and bilateral neck dissection, followed immediately by reconstructive surgery with a rectus abdominis muscle flap. As postoperative adjuvant chemotherapy, a regimen of TPF was started, but 2 days later, nausea and vomiting developed, which made oral intake difficult. Six days after treatment began, he experienced disturbance of consciousness. Because of respiratory arrest during cerebral computed tomography (CT) to assess these symptoms, the patient was transferred to the intensive care unit. <br>On CT, no structural abnormalities of the brain were noted; however, blood testing revealed a high NH3 level of 536μg/dL. With intravenous fluid therapy, the NH3 gradually decreased, the level of consciousness improved, and the NH3 returned to within normal limits. On the basis of the treatment course and absence of liver dysfunction, the hyperammonemia was attributed to 5-FU.However, 4 months after surgery, the atient had an unexpected outcome due to pulmonary metastasis.

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