The clinical importance of recognizing capecitabine-induced hypertriglyceridemia: A case report and review of the literature.

This case report describes a patient who developed a mixed hyperlipidemia and severe hypertriglyceridemia (>20 mmol/L or 1772 mg/dL) while receiving capecitabine chemotherapy. After lipid-lowering treatment (statin and omega-3 acid ethyl esters) and completion of chemotherapy, her lipid levels had been significantly reduced. Other secondary causes of hyperlipidemia were also investigated. In view of the abnormal lipid results worsened by capecitabine, we suggest that careful lipid monitoring and thorough lipid management are important in such patients to avoid acute pancreatitis.

Undetectable high-density lipoprotein cholesterol in acute malaria.

We report the case of a 39-year-old West African man in whom high-density lipoprotein cholesterol (HDL-C) was identified as undetectable at <0.08 mmol/L. Total cholesterol in the same sample was 2.85 mmol/L; triglycerides were only mildly elevated at 2.32 mmol/L. He was admitted with a 2-week history of polydipsia, polyuria, weight loss and hyperpyrexia. Dual malarial infection with Plasmodium ovale and falciparum was identified and attributed to a recent trip to Nigeria without chemoprophylaxis. Also, he was diagnosed with diabetes mellitus with random hyperglycemia of 39 mmol/L but no ketonemia. Subsequent investigation revealed a low apolipoprotein A1 of 0.38 g/L (1.04-2.02), confirming a true HDL-C deficit. On clinical examination, he had neither orange tonsils consistent with Tangier disease nor corneal opacification consistent with lecithin-cholesterol acyltransferase deficiency. The patient was an avid gym goer but denied anabolic steroid abuse, a fact supported by a transient primary testosterone deficiency at presentation (testosterone 6.56 nmol/L, RR 8.6-29; follicle-stimulating hormone high at 9.2 mU/L, luteinising hormone high at 11.9 mU/L). He was treated for malaria and started on metformin for diabetes. At 8-week follow-up, his HDL-C was entirely normal at 1.38 mmol/L. We believe this severe drop in HDL-C level to be due to acute inflammation caused by malaria. As extreme drops in HDL-C have been found to be associated with the poorest prognosis, prospective identification of HDL-C and prompt clinical liaison may be of benefit.