Reactions 699 - 2 May 1998

SAntineoplastics/corticosteroids

Fatal leucoencephalopathy: case reportFatal leucoencephalopathy occurred in a 56-year-old

woman with non-Hodgkin’s lymphoma following treatmentwith cyclophosphamide, doxorubicin, vincristine andprednisone (CHOP), followed by stress doses ofhydrocortisone.

On hospital day 3, the woman was treated with IVcyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2,vincristine 1.4 mg/m2 and oral prednisone 100mg (CHOP) for5 days. On day 8, she developed neutropenia and was treatedwith granulocyte colony-simulating factor, tazobactam-piperacillin and IV hydrocortisone 100mg every 8 hours. Onday 10, she had a tonic-clonic seizure associated withconfusion, blurred vision and a decreased level ofconsciousness. A CT brain scan showed subtle bilateraloccipital hypondense areas.

On day 15, the woman developed a dense right hemiparesiswith right-sided hyper-reflexia. A repeat CT scan showedprogression of the hypodense areas to involve the subcorticalwhite matter. Haematological recovery occurred on day 17and granulocyte colony-stimulating factor and antibacterialtherapy were discontinued. However, her neurological statusdeteriorated and her coma deepened. She died on day 19.Post-mortem brain examination showed diffuse white matteroedema with small areas of perivascular haemorrhage; the leftcerebral hemisphere was more severely affected.

Author comment: ‘The use of high-dose steroids withoutconcomitant use of other immunosuppressives such ascyclosprine has never been implicated as a cause ofleukoencephalopathy. The etiology of theleukoencephalopathy in this patient was likely multifactorial.This is the first case of a fatal leukoencephalopathy syndromedescribed in a patient receiving standard CHOP chemotherapyfor NHL [non-Hodgkin’s lymphoma], and may be related toadministration of high-dose steroids in combination withimmunosuppressive chemotherapy.’Cain MS, et al. Fatal leukoencephalopathy in a patient with non-Hodgkin’slymphoma treated with CHOP chemotherapy and high-dose steroids. AmericanJournal of the Medical Sciences 315: 202-207, Mar 1998 - USA 800659569

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Reactions 2 May 1998 No. 6990114-9954/10/0699-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved