Reactions 970 - 27 Sep 2003

★ SAntineoplastics

First report of cryptococcal meningitis: case reportA 15-year-old girl who had been diagnosed with acute

lymphoblastic leukaemia (ALL) developed cryptococcalmeningitis after receiving antineoplastic therapy.

The girl had received a 6-week course of induction therapycomprising vincristine 2 mg/m2/week, dexamethasone6 mg/m2/day, asparaginase 6000 units/m2 twice weekly inweeks 4 and 5, and intrathecal triple therapy consisting ofmethotrexate, prednisolone and cytarabine [dosages notstated]. She then received three courses of IV methotrexate2 g/m2 and intrathecal triple therapy, followed by 100 weeks’maintenance therapy consisting of intermittentdexamethasone 6 mg/m2 for 2 weeks with two doses ofvincristine 2 mg/m2, mercaptopurine 50 mg/m2 for 5 weeksand oral methotrexate 30 mg/m2. At the end of maintenancetherapy, she developed a severe headache and abducensparesis on her right side and cerebrospinal fluid (CSF) cultureconfirmed a diagnosis of Cryptococcus neoformans meningitis.She also had a very low peripheral blood T cell count (0.4 ×109).

The girl received amphotericin B and flucytosine for2 weeks, followed by oral fluconazole for 8 weeks, after whichher CSF was normal. Follow-up was uneventful and, at the endof treatment, her T cell count had normalised.

Author comment: "To our knowledge our patient is thefirst child reported with clinically evident cryptococcalmeningitis during treatment for non-high risk ALL in firstcomplete remission."Mavinkurve-Groothuis AMC, et al. Cryptococcal meningitis in a child with acutelymphoblastic leukemia. Pediatric Infectious Disease Journal 22: 576, Jun 2003 -Netherlands 800947760

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of cryptococcal meningitisassociated with asparaginase, dexamethasone, mercaptopurine,methotrexate or vincristine. The WHO Adverse Drug Reactionsdatabase contained two reports of cryptococcal meningitisassociated with dexamethasone, one with mercaptopurine, 31with methotrexate, nine with vincristine and no reports withasparaginase.

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Reactions 27 Sep 2003 No. 9700114-9954/10/0970-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved