Introduction:
The emergence of neuropsychiatric symptoms secondary to the use of antineoplastic agents is known but often underreported. Capecitabine and Oxaliplatin regimen is one of the standard chemotherapy regimens used in clinical practice for the treatment of carcinoma rectum. Capecitabine is a prodrug of 5-fluorouracil (5-FU) and is associated with several behavioral syndromes including encephalopathy, psychosis, and depression across heterogeneous subgroups. 1–7. However, the emergence of syndromal mania is rarely reported with Capecitabine use in carcinoma rectum. The exact mechanism of development of syndromal manic symptoms due to capecitabine is not fully known but few hypotheses are linked with inflammatory cascade implicated in cancer and mood disorders8,9. Further regular adherence to pharmacovigilance guidelines may be overlooked especially in such cases where behavioral adverse effects are the only manifestations. We report the development of Euphoric mania after the initiation of the third cycle of chemotherapy with capecitabine in one of the patients.