5-Fluorouracil-induced leukoencephalopathy in a patient with gastric adenocarcinoma: A case report

Clinical manifestation of 5-FU-induced leukoencephalopathy is characterized by disorientation, confusion, seizure, and unconsciousness. We present a case of acute leukoencephalopathy in a 32 years old female, with locally advanced poorly differentiated gastric adenocarcinoma undergoing treatment using the 5-fluorouracil-leucovorin-oxaliplatin-docetaxel (FLOT) regimen. The patient was reported with acute delirium, aphasia, acute confusional state, low Glasgow Coma Score (CGS), and irritability within 24 hours of her first FLOT cycle, which was administered to her for the treatment of gastric adenocarcinoma. A diffusion-weighted (DW)-MRI brain scan showed a bilateral symmetrical diffusion-restricted lesion in the white matter. A diagnosis of leukoencephalopathy was made based on clinical and radiological workup. 5-Fluorouracil was stopped and commenced on methylprednisolone and had dramatic recovery.