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Nicole M. WILSON, PHARM.D., is Assistant Professor of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, and Clinical Pharmacy Specialist, Hematology/ Oncology, St. Vincent Hospital, Indianapolis; at the time of writing, she was Oncology Pharmacy Practice Resident, The University of Texas M. D. Anderson Cancer Center, Houston. JANET L. ESPIRITO, PHARM.D., BCOP, is Clinical Pharmacy Specialist; VICENTE VALERO, M.D., is Professor of Medicine; and LAJOS PUSZTAI, M.D., PH.D., is Associate Professor of Medicine, Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center.

Address correspondence to Dr. Wilson at the Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 90, Houston, TX 77030 (nmwilson{at}butler.edu).

Purpose. A case of paclitaxel-induced painful crisis in a patient with breast cancer and hemoglobin sickle cell disease (SCD) is reported. Summary. A 55-year-old postmenopausal African-American woman had stage IIB invasive ductal carcinoma of the left breast. She was not taking any medications and did not report a history of cancer or other diseases. She had mild microcytic anemia, but the rest of her blood counts and liver function test values were normal. Bone scans and computed tomography scans of her chest and abdomen did not reveal any metastatic disease. She underwent a routine left segmental mastectomy and axillary lymph node dissection that revealed a 4-cm invasive cancer with 1 of 10 axillary lymph nodes positive for metastatic disease. Her treatment plan included chemotherapy with weekly paclitaxel, followed by fluorouracil, epirubicin, and cyclophosphamide and radiation. The first cycle of paclitaxel was well tolerated until one week after initiation when the patient woke up in the middle of the night with a sudden onset of excruciating back pain and muscle spasms. Other symptoms that developed included fatigue, left-sided rib pain, and shortness of breath. The patient recalled being told that she had sickle cell trait but said that she never had a sickle cell crisis. Laboratory tests during her 13-day hospitalization revealed hemolysis. The patient was diagnosed with hemoglobin SCD and later discharged with as-needed, low-dose oxycodone and baclofen, antibiotics, and folic acid. Conclusion. A patient with breast cancer and SCD had a painful crisis after receiving paclitaxel as part of her chemotherapy regimen. Index terms: Anemia; Antiinfective agents; Antineoplastic agents; Baclofen; Breast neoplasms; Cyclophosphamide; Epirubicin; Fluorouracil; Folic acid; Opiates; Oxycodone; Paclitaxel; Skeletal muscle relaxants; Toxicity; Vitamins