Severe multiorgan toxicities after the first cycle of standard-dose etoposide-cisplatin therapy for metastatic nonseminoma successfully managed with etoposide-carboplatin: a case report.

backgroundThe combination of bleomycin, etoposide, and cisplatin is the standard regimen for good-risk metastatic nonseminomatous germ cell tumors, with etoposide and cisplatin used when pulmonary risk is present. Etoposide and cisplatin therapy is generally well tolerated, and severe toxicities are particularly rare after the first standard-dose cycle. We report a case of early-onset, simultaneous multiorgan failure after a single cycle of etoposide and cisplatin therapy, successfully managed with etoposide-carboplatin. CASE PRESENTATION: A 54-year-old Japanese man with stage IIa nonseminomatous germ cell tumor received a standard-dose first cycle of etoposide and cisplatin therapy (etoposide 100 mg/m

conclusionThis case demonstrates that even a standard-dose, first-cycle etoposide and cisplatin regimen can trigger abrupt, life-threatening multiorgan toxicities affecting renal, hepatic, auditory, hematologic, and visual systems. Such early, simultaneous onset has rarely been described in scientific literature. When cisplatin continuation is unsafe, etoposide-carboplatin may serve as a feasible alternative to achieve remission while minimizing systemic toxicity. Careful evaluation of patient-specific risk factors, including hypertension, renal reserve, and renin-angiotensin system inhibitor use, is essential before initiating cisplatin-based therapy. This case highlights the importance of individualized treatment planning and prompt recognition of severe chemotherapy-induced toxicities.