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Case Report: Capecitabine-Induced Multifocal Leukoencephalopathy masquerading as Stroke in a 40-year-old male with Nasopharyngeal Carcinoma

Volume 4 - Issue 6, June 2020 Edition
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John Joshua Q. Punsalan, M.D., M.B.A.1, Marivic A. Guieb-Preysler, M.D., F.P.N.A.2
Acute Leukoencephalopathy; Capecitabine; Neurotoxicity; Chemotherapy
A 40-year-old male diagnosed with Nasopharyngeal Carcinoma St. IV undergoing chemo and radiotherapy was referred to our service because of sudden right upper extremity weakness. He had been started on Capecitabine 9 days prior to consult. A cranial MRI revealed bilateral and symmetric diffusion restriction over the centrum seimovale, corona radiata, internal capsule, cerebral peduncles. An acute leukoencephalopathy was considered, prompting discontinuation of capecitabine. Symptoms improved after 24 hours of discontinuation. Leukoencephalopathies among chemotherapeutic agents have been well-documented. Capecitabine has just recently gained prominence due to its more favorable safety profile and its side effects are less known. High index of suspicion through knowledge of all possible side effects is important, since symptoms commonly resolve upon discontinuation of the medication.
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