Gökmen AKTAŞ, Sengul SAHİN, Gulcin ELBOGA, Tülay KUŞ, Elif KARAYAĞMURLU, Perihan Gizem AKSOY, Abdurrahman ALTİNDAG

5-fluorouracil-induced manic episode in patients with colon cancer: A case report and literature review

The combination of 5-fluorouracil (5-FU), irinotecan and bevacizumab (FOLFIRI-beva) is one of the main treatment options formetastatic colon cancer. We present a rare case of irritable mood elevation during FOLFIRI-beva treatment in a man withoutpsychiatric history. A 41-year-old man with colon cancer developed a manic episode after four cycles of chemotherapy. Afterexcluding the other causes, the patient was diagnosed with Medication-induced Bipolar disorder manic episode with mixed featuresaccording to the criteria of Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Chemotherapy was discontinued,and antipsychotic treatment with haloperidol and biperidone was started. He recovered after 12 days. While adjustment disorders,depression and delirium are more common in cancer patients, mood disorders are rare during chemotherapy. Neuropsychiatricmanifestations are uncommon during 5-FU treatment. Clinicians should keep in mind that a neuropsychological condition or mooddisorders may be encountered during chemotherapy especially with 5-FU.

PDF

___

1. Derogatis LR, Morrow GR, Fetting J, et al. The prevalence of psychiatric disorders among cancer patients. Jama 1983;249:751-7.
2. Gopalan MR, Karunakaran V, Prabhakaran A, et al. Prevalence of psychiatric morbidity among cancer patients– hospital-based, cross-sectional survey. Indian J Psychiatry 2016;58:275-80.
3. Brown ES, Chandler PA. Mood and cognitive changes during systemic corticosteroid therapy. Prim Care Companion J Clin Psychiatry 2001;3:17-21.
4. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med 2004;34:513-54.
5. Fora A, Alabsi E, Fakih M. A Case of 5-Fluorouracil–Induced Acute Psychosis. Clin Colorectal Cancer 2009;8:166-8.
6. Pacchiarotti I, Mazzarini L, Pellegrini P, et al. A case of manic episode during treatment with 5-fluorouracil, epirubicin and cyclophosphamide for breast cancer. Gen Hosp Psychiatry 2007;29:461-3.
7. Brieger P, Marneros A, Wolf H, et al. Manic episode in an ifosfamide-treated patient. Gen Hosp Psychiatry 2000;22:52-3.
8. Kerdudo C, Orbach D, Sarradet JL, et al. Ifosfamide neurotoxicity: an atypical presentation with psychiatric manifestations. Pediatr Blood Cancer 2006;47:100-2.
9. Acharya G, Cruz Carreras MT, Rice TW. 5-FU-induced leukoencephalopathy with reversible lesion of splenium of corpus callosum in a patient with colorectal cancer. BMJ Case Rep 2017;2017:pii:bcr-2017-222030.
10. Niemann B, Rochlitz C, Herrmann R, et al. Toxic encephalopathy induced by capecitabine. Oncology 2004;66:331-5.
11. Yeh K, Cheng A. High-dose 5-fluorouracil infusional therapy is associated with hyperammonaemia, lactic acidosis and encephalopathy. Br J Cancer 1997;75:464-5.
12. Rundell JR, Wise MG. Causes of organic mood disorder. J Neuropsychiatry Clin Neurosci 1989;1:398-400.
13. Goodwin GM. Aromatase inhibitors and bipolar mood disorder: a case report. Bipolar Disord 2006;8:516-8.