Vascular Events during Chemotherapy in Treatment of Germ Cell Testicular Cancer

Introduction: We report a case of acute myocardial infarction and acute cerebral infarction during treatment with bleomycin, etoposide, and cisplatin (BEP) regimen for germ cell testicular cancer.

Case Presentation: A 28 year old smoker man diagnosed with germ cell testicular cancer without any history of ischemic heart disease complained of sudden chest pain on day 6 of his second cycle of chemotherapy. His electrocardiogram showed Q waves (Lead V1–V3) and T wave inversion (Lead V1–V3). He underwent primary percutanoeous coronary intervention (PCI) to the proximal left artery descending (LAD) lesion (95%) with thrombus aspirated with export catheter and predialated with percutaneous transluminal coronary angioplasty (PTCA) and bar metal stent (BMS) deployed in the LAD.

One week later; the patient developed left sided weakness and ptosis of left eyelid. Magnetic resonance angiography and venography to the head and neck showed total occlusion of left vertebral artery.

Discussion: Acute MI and cerebral infarction are uncommon in young man without cardiovascular risk factors such as hypertension, diabetes, or dyslipidemia. Thromboembolic events (TEEs) are more likely in our case presented without significant risk factors; which was confirmed in our case by coronary angiography.

Consclusion: Thromboembolic events are adverse events associated with chemotherapy treatment that may need further attention in regard to the initial prevention including pharmacological prophylaxis and possibility of an alternative regimen particularly in patients with testicular germ cell tumor.