Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen

a case report

Alexandra Sokolova, Onyee Chan, Waqas Ullah, Auon Abbas Hamdani, Faiz - Anwer

Research output: Contribution to journalArticle

Abstract

Background: High-dose chemotherapy with autologous stem cell rescue is commonly used for the treatment of relapsed germ cell tumors. We report the first case of delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen. Case presentation: We report a case of a 21-year-old African-American man diagnosed with relapsed non-seminomatous germ cell tumor who received high-dose chemotherapy with carboplatin and etoposide following TIGER trial arm B off-protocol. His course was complicated by muscle pain and rhabdomyolysis after cycle 4 on day +12 after infusion of autologous stem cells. To the best of our knowledge, this complication has not been reported with this regimen. A differential diagnosis of sepsis and neutropenic fever along with side effects of high-dose chemotherapy were considered, but based on the timing of events, it was concluded that the etiology of rhabdomyolysis is high-dose chemotherapy. Rhabdomyolysis was successfully treated with hydration and did not recur during subsequent cycle 5. Conclusions: Delayed rhabdomyolysis after high-dose chemotherapy with paclitaxel, ifosfamide, carboplatin, and etoposide regimen has not been previously reported and needs to be considered for preventive strategy and prompt diagnosis and treatment to avoid renal complications. Physicians should have a low threshold to check creatine kinase enzymes in patients with unexplained muscle pain or renal insufficiency after high-dose chemotherapy.

Original languageEnglish (US)
Article number100
JournalJournal of Medical Case Reports
Volume11
Issue number1
DOIs
StatePublished - Apr 11 2017

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Ifosfamide
Rhabdomyolysis
Carboplatin
Etoposide
Paclitaxel
Drug Therapy
Myalgia
Stem Cells
Germ Cell and Embryonal Neoplasms
Creatine Kinase
African Americans
Renal Insufficiency
Sepsis
Differential Diagnosis
Fever
Physicians
Kidney
Enzymes
Therapeutics

Keywords

  • Carboplatin
  • Etoposide
  • Rhabdomyolysis
  • Testicular cancer
  • TI-CE chemotherapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen : a case report. / Sokolova, Alexandra; Chan, Onyee; Ullah, Waqas; Hamdani, Auon Abbas; Anwer, Faiz -.

In: Journal of Medical Case Reports, Vol. 11, No. 1, 100, 11.04.2017.

Research output: Contribution to journalArticle

Sokolova, Alexandra ; Chan, Onyee ; Ullah, Waqas ; Hamdani, Auon Abbas ; Anwer, Faiz -. / Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen : a case report. In: Journal of Medical Case Reports. 2017 ; Vol. 11, No. 1.
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AB - Background: High-dose chemotherapy with autologous stem cell rescue is commonly used for the treatment of relapsed germ cell tumors. We report the first case of delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen. Case presentation: We report a case of a 21-year-old African-American man diagnosed with relapsed non-seminomatous germ cell tumor who received high-dose chemotherapy with carboplatin and etoposide following TIGER trial arm B off-protocol. His course was complicated by muscle pain and rhabdomyolysis after cycle 4 on day +12 after infusion of autologous stem cells. To the best of our knowledge, this complication has not been reported with this regimen. A differential diagnosis of sepsis and neutropenic fever along with side effects of high-dose chemotherapy were considered, but based on the timing of events, it was concluded that the etiology of rhabdomyolysis is high-dose chemotherapy. Rhabdomyolysis was successfully treated with hydration and did not recur during subsequent cycle 5. Conclusions: Delayed rhabdomyolysis after high-dose chemotherapy with paclitaxel, ifosfamide, carboplatin, and etoposide regimen has not been previously reported and needs to be considered for preventive strategy and prompt diagnosis and treatment to avoid renal complications. Physicians should have a low threshold to check creatine kinase enzymes in patients with unexplained muscle pain or renal insufficiency after high-dose chemotherapy.

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