Dihydropyrimidine dehydrogenase (DPD) is the limiting enzyme involved in the degradation of 5-FU and, therefore, there is a close relationship between DPD levels and the effect of capecitabine. The deficiency of this enzyme can cause severe toxicity even leading to death. We describe a case of grade IV mucocutaneous toxicity due to a possible DPD deficit, and analyzed the causality using the modified Karch-Lasagna algorithm. Although the screening of the DPD deficit would allow to individualize the doses in these patients, these determinations are not implemented in the daily practice of most hospitals
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