A 22-year-old man is currently a patient in an oncology ward. He had an osteosarcoma excised two years ago. He has been relatively well but is now having recurrent disease in his pelvis. He received chemotherapy one week ago and has been admitted for weakness and lethargy. He was previously completely fit and well until he developed the osteosarcoma in his right femur. This was treated surgically and with standard combination chemotherapy.
Since then, he has not had any further medical problems, until the development of recurrent disease in his pelvic bone. There is no evidence of disease elsewhere. The man had combination chemotherapy one week ago, which included ifosfamide. After the first few days of treatment, he felt slightly nauseated and weak, but in the last week or so, he has felt increasingly unwell. He has had difficulty walking any distance and getting from sitting to…
