5-fluorouracil-induced manic episode in patients with colon cancer: A case report and literature review

Abstract

The combination of 5-fluorouracil (5-FU), irinotecan and bevacizumab (FOLFIRI-beva) is one of the main treatment options for metastatic colon cancer. We present a rare case of irritable mood elevation during FOLFIRI-beva treatment in a man without psychiatric history. A 41-year-old man with colon cancer developed a manic episode after four cycles of chemotherapy. After excluding the other causes, the patient was diagnosed with Medication-induced Bipolar disorder manic episode with mixed features according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Chemotherapy was discontinued, and antipsychotic treatment with haloperidol and biperidone was started. He recovered after 12 days. While adjustment disorders, depression and delirium are more common in cancer patients, mood disorders are rare during chemotherapy. Neuropsychiatric manifestations are uncommon during 5-FU treatment. Clinicians should keep in mind that a neuropsychological condition or mood disorders may be encountered during chemotherapy especially with 5-FU.