Antineoplastics
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Reactions 1209 - 5 Jul 2008 S Antineoplastics Herpes simplex encephalitis and cytomegalovirus encephalitis in an elderly patient: case report A 75-year-old woman developed herpes simplex encephalitis and subsequent cytomegalovirus (CMV) encephalitis following chemoradiotherapy [time to reaction onset not stated]. The woman was diagnosed with diffuse large B-cell lymphoma, which affected multiple extranodal sites, and received six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone [dosages and duration of treatment not stated]. Subsequent radiological findings were compatible with CNS lymphoma and she was diagnosed with CNS relapse of diffuse large B-cell lymphoma. She then received high-dose methotrexate-based chemotherapy [duration of treatment not clearly stated]. Her regimen consisted of methotrexate 2.5 g/m 2 [frequency not stated], procarbazine [dosage not stated], dexamethasone and intrathecal methotrexate 12mg [frequency not stated]. During chemotherapy, she received dexamethasone at dosages of 16 mg/day, 12 mg/day, 8 mg/day, 6 mg/day, 4 mg/day and 2 mg/day in her first, second, third, fourth, fifth and sixth weeks, respectively. Following administration of high-dose methotrexate, she developed confusion, which spontaneously resolved. After three cycles, chemotherapy was discontinued. She underwent local brain irradiation with concurrent dexamethasone 2 mg/day [duration of treatment not stated]. Ten days after completion of radiotherapy, she presented with confusion, delirium and drowsiness, which progressed to unconsciousness. CSF analysis revealed two normal lymphocytes/mL, a glucose level of 65 mg/dL and a protein level of 63 mg/dL. Brain MRI findings were characteristic of herpes simplex encephalitis. The woman received IV aciclovir. PCR of CSF was positive for herpes simplex virus type 1 (HSV-1). An EEG revealed non- specific diffuse slow waves. Her symptoms partially improved and HSV-1 in her CSF disappeared. However, PCR analysis detected CMV in her CSF, which disappeared after administration of ganciclovir. Subsequently, a serological test for Aspergillus galactomannan antigen was positive and she received voriconazole. She also developed aspiration pneumonia. She subsequently died because of systemic progression of diffuse large B-cell lymphoma before consciousness was regained. Autopsy revealed marked infiltration of lymphoma cells in most of her organs. Immunostaining for HSV-1 and CMV was negative. Author comment: "[C]oncomitant infection of HSV-1 and CMV was probably attributed to immunosuppression with the underlying lymphoma and repeated chemotherapies. . . In summary, we experienced a case of [herpes simplex encephalitis] and subsequent CMV encephalitis after combined treatment with high-dose methotrexate and cranial irradiation". Suzuki HI, et al. Herpes simplex encephalitis and subsequent cytomegalovirus encephalitis after chemoradiotherapy for central nervous system lymphoma: a case report and literature review. International Journal of Hematology 87: 538-541, No. 5, Jun 2008 - Japan 801111822 1 Reactions 5 Jul 2008 No. 1209 0114-9954/10/1209-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1209 - 5 Jul 2008
SAntineoplastics
Herpes simplex encephalitis and cytomegalovirusencephalitis in an elderly patient: case report
A 75-year-old woman developed herpes simplexencephalitis and subsequent cytomegalovirus (CMV)encephalitis following chemoradiotherapy [time to reactiononset not stated].
The woman was diagnosed with diffuse large B-celllymphoma, which affected multiple extranodal sites, andreceived six cycles of rituximab, cyclophosphamide,doxorubicin, vincristine and prednisolone [dosages andduration of treatment not stated]. Subsequent radiologicalfindings were compatible with CNS lymphoma and she wasdiagnosed with CNS relapse of diffuse large B-cell lymphoma.She then received high-dose methotrexate-basedchemotherapy [duration of treatment not clearly stated]. Herregimen consisted of methotrexate 2.5 g/m2 [frequency notstated], procarbazine [dosage not stated], dexamethasone andintrathecal methotrexate 12mg [frequency not stated]. Duringchemotherapy, she received dexamethasone at dosages of16 mg/day, 12 mg/day, 8 mg/day, 6 mg/day, 4 mg/day and2 mg/day in her first, second, third, fourth, fifth and sixthweeks, respectively. Following administration of high-dosemethotrexate, she developed confusion, which spontaneouslyresolved. After three cycles, chemotherapy was discontinued.She underwent local brain irradiation with concurrentdexamethasone 2 mg/day [duration of treatment not stated].Ten days after completion of radiotherapy, she presented withconfusion, delirium and drowsiness, which progressed tounconsciousness. CSF analysis revealed two normallymphocytes/mL, a glucose level of 65 mg/dL and a proteinlevel of 63 mg/dL. Brain MRI findings were characteristic ofherpes simplex encephalitis.
The woman received IV aciclovir. PCR of CSF was positivefor herpes simplex virus type 1 (HSV-1). An EEG revealed non-specific diffuse slow waves. Her symptoms partially improvedand HSV-1 in her CSF disappeared. However, PCR analysisdetected CMV in her CSF, which disappeared afteradministration of ganciclovir. Subsequently, a serological testfor Aspergillus galactomannan antigen was positive and shereceived voriconazole. She also developed aspirationpneumonia. She subsequently died because of systemicprogression of diffuse large B-cell lymphoma beforeconsciousness was regained. Autopsy revealed markedinfiltration of lymphoma cells in most of her organs.Immunostaining for HSV-1 and CMV was negative.
Author comment: "[C]oncomitant infection of HSV-1 andCMV was probably attributed to immunosuppression with theunderlying lymphoma and repeated chemotherapies. . . Insummary, we experienced a case of [herpes simplexencephalitis] and subsequent CMV encephalitis aftercombined treatment with high-dose methotrexate and cranialirradiation".Suzuki HI, et al. Herpes simplex encephalitis and subsequent cytomegalovirusencephalitis after chemoradiotherapy for central nervous system lymphoma: a casereport and literature review. International Journal of Hematology 87: 538-541, No.5, Jun 2008 - Japan 801111822
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Reactions 5 Jul 2008 No. 12090114-9954/10/1209-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
