A 62-year-old woman, hypertensive and hypercholesterolaemic on pharmacological treatment. Diagnosed with stage IV adenocarcinoma of the colon with multiple liver metastases. Under chemotherapy treatment with mFOLFOX 6 + Bevacizumab (oxaliplatin 85 mg/m2 i.v. day 1, leucovorin 200 mg/m2 i.v. day 1, 5-FU 400 mg/m2 i.v. bolus day 1, 5-FU 1. 200 mg/m2/day in a 48 h continuous infusion and bevacizumab 5 mg/kg i.v. day 1) with good tolerance, except for neurotoxicity that causes the suspension of oxaliplatin after cycle no. 15. He began with a sudden onset of pain and itching in the right costal region, with painful bullous lesions, metamaterally distributed, ulcerated and suppurative. She consulted her primary care physician, who prescribed treatment for VZV with brivudine (Nervinex® 125 mg tablets) 1 tablet/24 h v.o. for 7 days, of which she only took 4 days as the treatment was replaced by famciclovir. Chemotherapy was postponed until the lesions improved, and the next cycle was given 4 days after the end of the brivudine treatment. Eleven days later, she came to the emergency department with abdominal pain with expulsion of melaenic stools, pain in the oral cavity and dysphagia. On arrival at the ED, she was afebrile, with blood pressure of 101/68 mmHg, heart rate of 79 bpm, and baseline oxygen saturation of 100%. The haemogram showed marked leukopenia, with neutrophil count of 50/µl, and thrombopenia (61 χ 103 platelets/µl). Respiratory and contact isolation was established. Serum therapy and treatment with broad-spectrum intravenous antibiotic therapy was started (meropenem plus vancomycin, then amikacin, acyclovir and fluconazole, which was replaced by caspofungin after 7 days of treatment due to fever and sustained neutropenia). Despite treatment, he presented frequent febrile peaks, so repeated blood cultures were performed, which were sterile, as well as antifungal antibody, β-glucan and galactomannan tests, which were negative. Granulocyte colony stimulating factors (filgrastim) were administered, 2 platelet concentrates were transfused and total parenteral nutrition was started. For pain management, analgesia with morphine, adjuvant NSAIDs, topical application of 2% viscous lidocaine and sucralfate for oral lesions were prescribed. Topical treatment of the herpetic lesions on the right side was with 0.1% zinc sulphate fomentation. Physical examination revealed marked generalised skin pigmentation and alopecia, both related to 5-FU toxicity. Despite the established supportive measures, there was a worsening of the general condition, with abundant respiratory secretions, poor pain control, without haematological recovery (last blood test: platelets = 51 χ 103 µl; neutrophils = 370/µl). The patient died of acute respiratory failure due to sepsis of respiratory origin.