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Despite normal results from standard DPYD genotyping prior to treatment, he developed severe gastrointestinal toxicity that progressed to bowel ischaemia and ultimately death. This case underscores the potential limitations of current genotyping approaches, which may not detect rare or functionally significant DPYD variants. It also highlights the need for a cautious and comprehensive approach to fluoropyrimidine therapy, especially in patients who develop unexpected toxicity, while recognising that other contributing factors may be involved.<\/jats:p>","DOI":"10.1136\/bcr-2025-265589","type":"journal-article","created":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T20:50:20Z","timestamp":1756673420000},"page":"e265589","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Suspected capecitabine-induced fatal toxicity in the context of a new DPYD variant"],"prefix":"10.1136","volume":"18","author":[{"given":"Phu Ngone","family":"Thet","sequence":"first","affiliation":[{"name":"Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK"},{"name":"Southampton General Hospital, Southampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5269-1160","authenticated-orcid":false,"given":"Taha","family":"Khalid","sequence":"additional","affiliation":[{"name":"Medical oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalind","family":"Ganderton","sequence":"additional","affiliation":[{"name":"Wessex genomic laboratory service, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Iveson","sequence":"additional","affiliation":[{"name":"Medical oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,31]]},"reference":[{"key":"2025083113500917000_18.8.e265589.1","doi-asserted-by":"crossref","unstructured":"Cura Y , P\u00e9rez-Ram\u00edrez C , S\u00e1nchez-Mart\u00edn A , et al . n.d. 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