{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T18:13:14Z","timestamp":1778695994640,"version":"3.51.4"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fluoropyrimidines are among the most common chemotherapeutic agents associated with cardiotoxicity, typically presenting as angina due to coronary vasospasm. Severe manifestations such as myocarditis and cardiogenic shock are rare, and rechallenge after cardiotoxicity is generally discouraged. We report a case of acute 5-fluorouracil\u2013induced myocarditis with successful rechallenge after multidisciplinary evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 30-year-old man with unresectable rectal adenocarcinoma developed acute cardiotoxicity during the first FOLFOX-6 cycle, presenting with abdominal pain and palpitations. ECG showed atrial fibrillation and ST-segment elevation. Echocardiography revealed severe biventricular dysfunction with elevated cardiac biomarkers. Coronary angiography excluded obstructive disease, and cardiac magnetic resonance confirmed acute myocarditis with diffuse oedema and non-ischaemic late gadolinium enhancement. Guideline-directed heart failure therapy led to rapid functional recovery within days. Following multidisciplinary cardio-oncology assessment, chemotherapy rechallenge under continuous monitoring was performed without recurrence of major adverse events. Subsequent cycles were well tolerated, and follow-up CMR showed preserved ventricular function with residual non-ischaemic LGE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights the importance of early recognition of fluoropyrimidine cardiotoxicity, the role of multidisciplinary cardio-oncology management, and the potential feasibility of rechallenge in carefully selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag285","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T11:43:51Z","timestamp":1776858231000},"source":"Crossref","is-referenced-by-count":0,"title":["Severe acute myocarditis induced by 5-fluorouracil with successful rechallenge after multidisciplinary cardio-oncology evaluation: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3130-0079","authenticated-orcid":false,"given":"Alessandra","family":"Greco","sequence":"first","affiliation":[{"name":"Cardiology Unit, Fondazione IRCCS Policlinico San Matteo , Piazzale Golgi 19, 27100 Pavia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Pagani","sequence":"additional","affiliation":[{"name":"Oncology Unit, Fondazione IRCCS Policlinico San Matteo , Piazzale Golgi 19, 27100 Pavia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Modugno","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Fondazione IRCCS Policlinico San Matteo , Piazzale Golgi 19, 27100 Pavia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Iengo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Fondazione IRCCS Policlinico San Matteo , Piazzale Golgi 19, 27100 Pavia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianpiero","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Oncology Unit, Fondazione IRCCS Policlinico San Matteo , Piazzale Golgi 19, 27100 Pavia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlotta","family":"Faverio","sequence":"additional","affiliation":[{"name":"Oncology Unit, Fondazione IRCCS Policlinico San Matteo , Piazzale Golgi 19, 27100 Pavia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Pedrazzoli","sequence":"additional","affiliation":[{"name":"Oncology Unit, Fondazione IRCCS Policlinico San Matteo , Piazzale Golgi 19, 27100 Pavia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo","family":"De Luca","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Fondazione IRCCS Policlinico San Matteo , Piazzale Golgi 19, 27100 Pavia ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2026051313284417100_ytag285-B1","doi-asserted-by":"crossref","first-page":"zrae038","DOI":"10.1093\/bjsopen\/zrae038","article-title":"Neoadjuvant treatment of colorectal cancer: Comprehensive review","volume":"8","author":"Smith","year":"2024","journal-title":"BJS Open"},{"key":"2026051313284417100_ytag285-B2","doi-asserted-by":"crossref","first-page":"4229","DOI":"10.1093\/eurheartj\/ehac244","article-title":"2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)","volume":"43","author":"Lyon","year":"2022","journal-title":"Eur Heart J"},{"key":"2026051313284417100_ytag285-B3","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s12012-020-09562-w","article-title":"Various manifestations of 5-fluorouracil cardiotoxicity: a multicenter case series and review of literature","volume":"20","author":"Allison","year":"2020","journal-title":"Cardiovasc Toxicol"},{"key":"2026051313284417100_ytag285-B4","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1080\/0284186X.2019.1711164","article-title":"Incidence and risk markers of 5-fluorouracil and capecitabine cardiotoxicity in patients with colorectal cancer","volume":"59","author":"Dyhl-Polk","year":"2020","journal-title":"Acta Oncol"},{"key":"2026051313284417100_ytag285-B5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11912-016-0521-1","article-title":"Fluoropyrimidine-induced cardiotoxicity: manifestations, mechanisms, and management","volume":"18","author":"Layoun","year":"2016","journal-title":"Curr Oncol Rep"},{"key":"2026051313284417100_ytag285-B6","doi-asserted-by":"crossref","first-page":"e0115686","DOI":"10.1371\/journal.pone.0115686","article-title":"Effects of 5-fluorouracil on morphology, cell cycle, proliferation, apoptosis, autophagy and ROS production in endothelial cells and cardiomyocytes","volume":"10","author":"Focaccetti","year":"2015","journal-title":"PLoS One"},{"key":"2026051313284417100_ytag285-B7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/2050-6511-15-47","article-title":"A systematic review of the pathophysiology of 5-fluorouracil-induced cardiotoxicity","volume":"15","author":"Polk","year":"2014","journal-title":"BMC Pharmacol Toxicol"},{"key":"2026051313284417100_ytag285-B8","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.tox.2016.10.001","article-title":"An integrative view of cisplatin-induced renal and cardiac toxicities: molecular mechanisms, current treatment challenges and potential protective measures","volume":"371","author":"Dugbartey","year":"2016","journal-title":"Toxicology"},{"key":"2026051313284417100_ytag285-B9","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1002\/cncr.30321","article-title":"Emergency use of uridine triacetate for the prevention and treatment of life-threatening 5-fluorouracil and capecitabine toxicity","volume":"123","author":"Ma","year":"2017","journal-title":"Cancer"},{"key":"2026051313284417100_ytag285-B10","doi-asserted-by":"crossref","first-page":"4426","DOI":"10.3390\/jcm10194426","article-title":"Cardiotoxicity of fluoropyrimidines: epidemiology, mechanisms, diagnosis, and management","volume":"10","author":"Jurczyk","year":"2021","journal-title":"J Clin Med"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag285\/68148098\/ytag285.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/5\/ytag285\/68148098\/ytag285.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/5\/ytag285\/68148098\/ytag285.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T17:28:50Z","timestamp":1778693330000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag285\/8661785"}},"subtitle":[],"editor":[{"given":"Anastasia","family":"Vamvakidou","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Mattia","family":"Alberti","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Rasha Mohamed","family":"Abayazeed","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":10,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag285","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,24]]},"article-number":"ytag285"}}