Abstract
The patient was a 51-year-old man with advanced gastric cancer showing peritoneal dissemination. He received neoadjuvant chemotherapy with capecitabine and cisplatin. CT revealed no evidence of peritoneal dissemination after 6 courses of neoadjuvant chemotherapy. Total gastrectomy and D2 lymph node dissection were performed. Postoperatively, he received an additional two courses of chemotherapy with capecitabine and cisplatin. He was admitted to our hospital suffering from severe diarrhea (Grade 3) and dehydration (Grade 4). On hospital day 8, he experienced severe complications with neutropenia (Grade 4) and thrombocytopenia (Grade 4). Although these side effects improved with daily transfusion of G-CSF and thrombocytes, diarrhea did not resolve. A diagnosis of cytomegalovirus (CMV) colitis was made on the basis of positive CMV antigenemia and colonoscopy. He recovered from colitis following administration of ganciclovir. Dihydropyrimidine dehydrogenase (DPD) levels were markedly low, at 21.5 U/mg protein. DPD is the rate-limiting enzyme for 5-fluorouracil (FU) catabolism. DPD-deficient cancer patients have been shown to develop severe toxicity after FU administration. In conclusion, we should keep in mind that some patients show deficiency or low activity of DPD and CMV colitis can arise as an opportunistic infection.
