高血氨腦病變是5-fluorouracil (5-FU) 引起之罕見且嚴重的中樞神經不良反應。過去研究認為，高血氨腦病變的發生風險與5-FU 的治療劑量有關，低劑量5-FU 治療的案例並不常見。而5-FU 引起高血氨腦病變的機轉推測與代謝中產物有關，且病人合併有誘發因子時可能增加發生風險。本文報導一位頭頸癌病人疑似因合併有腎功能不全、過瘦及感染等多重誘發因子，在接受低劑量5-FU 化療後發生高血氨腦病變的罕見案例，並針對族群特性及重新投藥的可行性進行文獻探討。對於接受低劑量5-FU 治療的病人，臨床醫療人員仍應審慎評估病人是否具有誘發因子並留意病人給藥後的意識變化。

 

Hyperammonemic encephalopathy, a rare but serious adverse reaction involving the central nervous system, may occur after 5-fluorouracil (5-FU) administration. Studies have reported a correlation between the occurrence of hyperammonemic encephalopathy and the dosage of 5-FU, with cases being uncommon in low-dose 5-FU treatments. The underlying mechanism of 5-FU-induced hyperammonemic encephalopathy is related to its metabolic intermediate product, and the risk of occurrence may increase in patients with precipitating factors. In this report, we describe a rare case of suspected hyperammonemic encephalopathy following lowdose 5-FU chemotherapy in a patient with head and neck cancer who had multiple precipitating factors, including renal insufficiency, low body weight, and infection.  We have additionally presented a literature review of population-specific factors and the feasibility of a 5-FU re-treatment. For patients treated with low-dose 5-FU, healthcare professionals should still undergo careful evaluation for precipitating factors, and should closely monitor any changes in consciousness after the administration of lowdose 5-FU.

 

 

Submitted for publication: 2023.2.21; Accepted for publication: 2023.5.15