Hypersensitivity reactions (HSR) to oxaliplatin in patients with
colorectal cancer include facial flushing, erythema, pruritis, fever,
tachycardia, dyspnea, tongue swelling, rash/hives, headache, chills,
weakness, vomiting, burning sensations, dizziness, and edema. We report
a patient with fever as the sole manifestation of initial HSR, review
the literature and discuss the management of HSR. A 57-year-old female
with T3N2M0 rectal adenocarcinoma received modified FOLFOX-6. She
tolerated the first 8 cycles without any toxicities except grade 1
peripheral neuropathy and nausea. During 9(th) and 10(th) infusions, she
developed fever to a maximum of 38.3 degrees C with stable hemodynamic
status despite medications. During 11(th) infusion, she developed grade
3 HSR consisting of symptomatic bronchospasm, hypotension, nausea,
vomiting, cough, and fever. On examination, she was pale, cyanotic, with
a temperature of 38.8 degrees C, BP dropped to 95/43 mm Hg, pulse of
116/min and O-2 saturation of 88%-91%. She was hospitalized for
management and recovered in 24 h. Fever alone is not a usual symptom of
oxaliplatin HSR. It may be indicative that the patient may develop
serious reactions subsequently, as did our patient who developed
hypotension with the third challenge. Treatment and prevention consists
of slowing the infusion rate, use of steroids and antagonists of Type 1
and 2 histamine receptor antagonists, whereas desensitization could help
to provide the small number of patients who experience severe HSR with
the ability to further receive an effective therapy for their colorectal
cancer. (C) 2007 WJG. All rights reserved.
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