A 62-year-old woman with hypertension and hypercholesterolaemia on pharmacological treatment.
She was diagnosed with stage IV colon adenocarcinoma with multiple liver metastases.
In chemotherapy treatment with mFOLFOX 6 scheme after beta-blockade (oxaliplatin 85 mg/m2 daily IV) or continuous brain damage caused by i.v. 200 mg/m2 daily 1.5FUizumab 400
It begins with a sudden pain and stinging in the right costal region, with painful bullous lesions of metameral distribution, ulcerated and suppurative.
Consultation with a primary care physician, who established treatment for VZV with urticaria (Nervinex® 125 mg tablets) 1 tablet/24 hr.o for 7 days, of which she was treated for only 4 days.
Chemotherapy is continued until lesions improve, and the next cycle is started 4 days after the end of treatment with bridin.
After eleven days, the patient came to the emergency room with abdominal pain with fecal incontinence, pain in the oral cavity and dysphagia.
Upon arrival to the emergency department, the patient presented with malaise, blood pressure of 101/68 mmHg, heart rate of 79 bpm, and basal oxygen saturation of 100%.
A marked leukopenia was observed in the blood count, with neutrophil counts of 50/μl, and thrombopenia (61 χ 103 platelets/μl).
Respiratory and contact isolation was established.
Serotherapy and treatment with intravenous broad-spectrum antibiotics (meropen plus vancomycin) were initiated, later on amikacin, ablative and fluconazole were replaced by casuistic treatment for neutropenia at 7 days.
Despite the treatment, she presented frequent episodes, so blood tests were performed, which were sterile, as well as determinations of antimycolium antibodies, β-glucan were negative and repeated feverish peaks, which were negative.
Granulocyte colony stimulating factors were administered (filgrastim), two platelet concentrates were transfused and total parenteral nutrition was established.
For the treatment of pain, analgesia was provided with morphine, adjuvant with NSAIDs, topical application of 2% viscous lidocaine and sucralfate for oral lesions.
Topical treatment of herpetic lesions on the right side was done with 0.1% zinc sulphate stimulations.
On physical examination, a marked generalized skin pigmentation and alopecia, both related to 5-FU toxicity, should be noted.
Despite the support measures established, there was a worsening of the general condition, with abundant respiratory secretions, poor pain, without recovery neutrophils (multiple control: platelets = 51 x 103 μl).
The patient died of acute respiratory failure within a sepsis of respiratory origin.
