• Yuya Hagiwara, Yoshiyuki Yamamoto, Yuki Inagaki, Reina Tomisaki, Miki Tsuji, Soma Fukuda, Satoshi Fukuda, Tsubasa Onoda, Hirosumi Suzuki, Yusuke Niisato, Yoshitaka Tange, Naoya Ikeda, Keiichi Yamada, Mariko Kobayashi, Daisuke Akutsu, Takeshi Yamada, Toshikazu Moriwaki, Toshiaki Narasaka, Hideo Suzuki, and Kiichiro Tsuchiya.
• Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan.
• Intern. Med. 2022 Aug 15; 61 (16): 2449-2455.

AbstractDihydropyrimidine dehydrogenase (DPD) deficiency induces severe adverse events in patients receiving fluoropyrimidines. We encountered a 64-year-old DPD-deficient man with a severe capecitabine-related gastrointestinal disorder. He received capecitabine-containing chemotherapy after rectal cancer resection. During the first course of chemotherapy, he developed severe diarrhea, a fever, and hematochezia. Endoscopy revealed mucosal shedding with bleeding throughout the gastrointestinal tract. DPD deficiency was suspected because he developed many severe adverse events of capecitabine early and was finally confirmed based on the finding of a low DPD activity level in peripheral blood mononuclear cells. After one month of intensive care, hemostasis and mucosal healing were noted, although his gastrointestinal function did not improve, and he had persistent nutritional management issues.

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