Case Report
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2007; 13(39): 5277-5281
Published online Oct 21, 2007. doi: 10.3748/wjg.v13.i39.5277
Fever as the only manifestation of hypersensitivity reactions associated with oxaliplatin in a patient with colorectal cancer Oxaliplatin-induced hypersensitivity reaction
M Wasif Saif, Shailja Roy, Leslie Ledbetter, Jennifer Madison, Kostas Syrigos
M Wasif Saif, Shailja Roy, Yale University School of Medicine, New Haven, CT 06520, United States
Leslie Ledbetter, Jennifer Madison, University of Alabama at Birmingham, Birmingham, AL, United States
Kostas Syrigos, Athens Medical School, Sotiria General Hospital, Athens, Greece
Author contributions: All authors contributed equally to the work.
Correspondence to: M Wasif Saif, MD, MBBS, Associate Professor, Section of Medical Oncology, Yale University School of Medicine, 333 Cedar Street; FMP: 116, New Haven, CT 06520, United States.
Telephone: +1-203-7371569 Fax: +1-203-7853788
Received: May 25, 2007
Revised: August 20, 2007
Accepted: September 1, 2007
Published online: October 21, 2007

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 9th and 10th infusions, she developed fever to a maximum of 38.3°C with stable hemodynamic status despite medications. During 11th 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°C, BP dropped to 95/43 mm Hg, pulse of 116/min and O2 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.

Keywords: Oxaliplatin, Hypersensitivity reaction, Fever, Colon cancer