Antineoplastics
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Reactions 1167 - 1 Sep 2007 S Antineoplastics Guillain-Barre syndrome: case report A 51-year-old man with Non-Hodgkin’s lymphoma developed Guillain-Barre syndrome during treatment with cyclophosphamide, doxorubicin, vincristine, methylprednisolone (CHOP) and rituximab. The man was diagnosed with Non-Hodgkin’s lymphoma in August 2005 and received an initial course of cyclophosphamide 750 mg/m 2 , doxorubicin 50 mg/m 2 , vincristine 1.4 mg/m 2 and methylprednisolone 100mg. He then received four cycles of CHOP [dosages not clearly stated] and rituximab 375 mg/m 2 every 2 weeks, ending in October 2005. After the first three cycles, he reported mild fingertip paraesthesia. Three weeks after the fourth cycle and 2 weeks after a transient fever, he reported worsening finger paraesthesia and rapidly progressive weakness of his legs, which extended to his bulbar muscles and arms with difficulty swallowing within 2 days. Three days after onset of weakness, a neurological examination revealed symmetrical, severe, predominately distal, flaccid quadriparesis, which was more pronounced in his legs, with absent deep tendon reflexes. Laboratory investigations revealed decreased WBC and lymphocytes counts and increased cerebrospinal fluid proteins (72 mg/dL). Four days after onset, nerve conduction studies revealed conduction blocks in his right peroneal, right and left tibialis posterior nerves, reduced motor conduction velocities and increased distal and F wave latencies in the median nerves, which also had decreased distal compound muscle action potential amplitudes. The man received daily plasma exchanges but, his condition worsened and he became bedridden. He received high-dose immune globulin and IV methylprednisolone and his condition moderately improved. However, 1 week later, his condition deteriorated again and he was transferred to an ICU and received non-invasive assisted ventilation and methylprednisolone and immune globulin for 2 days. His condition gradually improved, but he experienced a slight deterioration about 3 weeks later. He received methylprednisolone and immune globulin for 2 days and his condition progressively improved. At follow-up 2 months later, he was able to walk normally for several meters without support. Author comment: "Several factors may have contributed to the development of [Guillain-Barre syndrome] in this patient, including [Non-Hodgkin’s lymphoma] itself, a possible antecedent infection suggested by the transient fever, and chemotherapy with CHOP and rituximab." Terenghi F, et al. Guillain-Barre syndrome after combined CHOP and rituximab therapy in non-Hodgkin lymphoma. Journal of the Peripheral Nervous System 12: 142-143, No. 2, Jun 2007 - Italy 801094972 1 Reactions 1 Sep 2007 No. 1167 0114-9954/10/1167-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1167 - 1 Sep 2007
SAntineoplastics
Guillain-Barre syndrome: case reportA 51-year-old man with Non-Hodgkin’s lymphoma
developed Guillain-Barre syndrome during treatment withcyclophosphamide, doxorubicin, vincristine,methylprednisolone (CHOP) and rituximab.
The man was diagnosed with Non-Hodgkin’s lymphoma inAugust 2005 and received an initial course ofcyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2,vincristine 1.4 mg/m2 and methylprednisolone 100mg. Hethen received four cycles of CHOP [dosages not clearly stated]and rituximab 375 mg/m2 every 2 weeks, ending inOctober 2005. After the first three cycles, he reported mildfingertip paraesthesia. Three weeks after the fourth cycle and2 weeks after a transient fever, he reported worsening fingerparaesthesia and rapidly progressive weakness of his legs,which extended to his bulbar muscles and arms with difficultyswallowing within 2 days. Three days after onset of weakness,a neurological examination revealed symmetrical, severe,predominately distal, flaccid quadriparesis, which was morepronounced in his legs, with absent deep tendon reflexes.Laboratory investigations revealed decreased WBC andlymphocytes counts and increased cerebrospinal fluid proteins(72 mg/dL). Four days after onset, nerve conduction studiesrevealed conduction blocks in his right peroneal, right and lefttibialis posterior nerves, reduced motor conduction velocitiesand increased distal and F wave latencies in the median nerves,which also had decreased distal compound muscle actionpotential amplitudes.
The man received daily plasma exchanges but, his conditionworsened and he became bedridden. He received high-doseimmune globulin and IV methylprednisolone and his conditionmoderately improved. However, 1 week later, his conditiondeteriorated again and he was transferred to an ICU andreceived non-invasive assisted ventilation andmethylprednisolone and immune globulin for 2 days. Hiscondition gradually improved, but he experienced a slightdeterioration about 3 weeks later. He receivedmethylprednisolone and immune globulin for 2 days and hiscondition progressively improved. At follow-up 2 monthslater, he was able to walk normally for several meters withoutsupport.
Author comment: "Several factors may have contributedto the development of [Guillain-Barre syndrome] in thispatient, including [Non-Hodgkin’s lymphoma] itself, apossible antecedent infection suggested by the transient fever,and chemotherapy with CHOP and rituximab."Terenghi F, et al. Guillain-Barre syndrome after combined CHOP and rituximabtherapy in non-Hodgkin lymphoma. Journal of the Peripheral Nervous System 12:142-143, No. 2, Jun 2007 - Italy 801094972
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Reactions 1 Sep 2007 No. 11670114-9954/10/1167-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
