Peripheral neuropathy exacerbation associated with topical 5-fluorouracil.
Peripheral neuropathy exacerbation associated with topical 5-fluorouracil.
复制标题
与局部 5-氟尿嘧啶相关的周围神经病变恶化。
DOI：
10.1097/01.cad.0000231479.30524.0e
复制
发表时间：
2006
影响因子：
2.3
通讯作者：
Diasio,RobertB
中科院分区：
文献类型：
--
作者：
Saif,MuhammadWasif;Hashmi,Shahrukh;Mattison,Lori;Donovan,WilliamB;Diasio,RobertB
周围神经病变继发于5-氟尿嘧啶和卡培他滨（希罗达）有报道。我们报告了第一例与外用5-氟尿嘧啶（Efudex）相关的周围神经病变加重。一位70岁的白种人男性，有15年的光化性角化病的病史，间歇性地局部应用5-氟尿嘧啶治疗。他同时也出现感觉周围神经病变，但广泛的检查没有明确的病因。2005年初，患者在接受了21天的5-氟尿嘧啶治疗光化性角化病，特别是疼痛和感觉异常后，周围神经病变恶化。用放射法和[2-13 C]尿嘧啶呼吸试验评价外周血单核细胞二氢嘧啶脱氢酶活性。二氢嘧啶脱氢酶活性均在正常范围内。停用5-氟尿嘧啶可使症状恢复到基线水平。代替外用5-氟尿嘧啶，外用咪喹莫特没有加重他的神经病变。他没有再次使用5-氟脲嘧啶。已知外用5-氟尿嘧啶主要引起皮肤不良反应，但由于吸收也可能引起全身反应，特别是在二氢嘧啶脱氢酶缺乏的患者中。由于我们的患者没有其他原因导致其神经病变，症状的发作与局部应用5-氟尿嘧啶的历史吻合，并且5-氟尿嘧啶的使用先于感觉症状的恶化，我们得出结论，该药物是导致其多发性神经病变的原因。
Peripheral neuropathy secondary to 5-flourouracil and capecitabine (Xeloda) has been reported. We report the first case of exacerbation of peripheral neuropathy related to topical 5-flourouracil (Efudex). A 70-year-old Caucasian male with a history of actinic keratosis for 15 years was treated intermittently with topical application of 5-flourouracil. He also developed sensory peripheral neuropathy around the same time, but extensive work-up disclosed no clear etiology. In early 2005, he developed an exacerbation of his peripheral neuropathy following a 21-day course of topical 5-flourouracil for actinic keratosis, especially pain and parasthesias. Dihydropyrimidine dehydrogenase activity was evaluated in the peripheral mononuclear cells both by radioassay and by [2-13 C] uracil breath test. Dihydropyrimidine dehydrogenase activity was within the normal range by both methods. Stopping topical 5-flourouracil resolved the symptoms to baseline. Instead of topical 5-flourouracil, topical imiquimod was used which did not exacerbate his neuropathy. He was not re-challenged with topical 5-flourouracil. Topical 5-flourouracil has been known to cause mainly dermatological adverse effects, but systemic effects because of absorption are possible, especially in dihydropyrimidine dehydrogenase-deficient patients. As our patient had no other cause responsible for his neuropathy, the onset of symptoms coincided historically with topical application of 5-flourouracil and the 5-flourouracil usage preceded an exacerbation of sensory symptoms, we conclude that this drug was responsible for his polyneuropathy.