Antineoplastics
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Reactions 618 - 14 Sep 1996 S Antineoplastics Ischaemic optic neuropathy: case report Ischaemic optic neuropathy developed in a 49-year-old woman with breast cancer after she received treatment with antineoplastics and an autologous bone marrow transplant. The patient was treated with several antineoplastic agents, including doxorubicin, cyclophosphamide, methotrexate and fluorouracil over an 18-month period. She was then treated with cyclophosphamide 5.6 g/m 2 over a 3-day period, cisplatin 165 mg/m 2 over 3 days, and a single dose of carmustine 600 mg/m 2 , with bone marrow and blood progenitor cells for haematopoietic support. Six weeks later, she began to experience visual loss in her left eye. She was treated with prednisone for presumed retrobulbar optic neuropathy. Approximately 10 days later, the woman had worsening vision in her left eye and decreased visual acuity in her right eye. After treatment with oral and IV corticosteroids, her sight stabilised and she was discharged home on tapering corticosteroids. Her visual acuity then remained stable, but she had decreased vision in her left eye. She died of respiratory failure approximately 2 months later. At autopsy, the optic chiasm showed extensive focal subacute demyelination with oedema, myelin pallor, large numbers of foamy macrophages and reactive astrocytes in the adjacent tissue. The optic nerve showed similar extensive demyelination with debris-laden macrophages. Author comment: ‘While paraneoplastic demyelination or Devic-type multiple sclerosis cannot be totally excluded on the basis of the patient’s history or the histopathology of the central nervous system, the most likely explanation is that these changes represent a drug reaction resulting in multi-focal demyelination or loss of myelinated fibers.’ Rubin P, et al. Ocular toxicity following high dose chemotherapy and autologous transplant. Bone Marrow Transplantation 18: 253-256, Jul 1996 - USA 800466822 1 Reactions 14 Sep 1996 No. 618 0114-9954/10/0618-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 618 - 14 Sep 1996
SAntineoplastics
Ischaemic optic neuropathy: case reportIschaemic optic neuropathy developed in a 49-year-old
woman with breast cancer after she received treatment withantineoplastics and an autologous bone marrow transplant.
The patient was treated with several antineoplastic agents,including doxorubicin, cyclophosphamide, methotrexate andfluorouracil over an 18-month period. She was then treatedwith cyclophosphamide 5.6 g/m2 over a 3-day period, cisplatin165 mg/m2 over 3 days, and a single dose of carmustine 600mg/m2, with bone marrow and blood progenitor cells forhaematopoietic support. Six weeks later, she began toexperience visual loss in her left eye. She was treated withprednisone for presumed retrobulbar optic neuropathy.
Approximately 10 days later, the woman had worseningvision in her left eye and decreased visual acuity in her righteye. After treatment with oral and IV corticosteroids, her sightstabilised and she was discharged home on taperingcorticosteroids. Her visual acuity then remained stable, butshe had decreased vision in her left eye. She died of respiratoryfailure approximately 2 months later.
At autopsy, the optic chiasm showed extensive focalsubacute demyelination with oedema, myelin pallor, largenumbers of foamy macrophages and reactive astrocytes in theadjacent tissue. The optic nerve showed similar extensivedemyelination with debris-laden macrophages.
Author comment: ‘While paraneoplastic demyelination orDevic-type multiple sclerosis cannot be totally excluded on thebasis of the patient’s history or the histopathology of the centralnervous system, the most likely explanation is that thesechanges represent a drug reaction resulting in multi-focaldemyelination or loss of myelinated fibers.’Rubin P, et al. Ocular toxicity following high dose chemotherapy and autologoustransplant. Bone Marrow Transplantation 18: 253-256, Jul 1996 -USA 800466822
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Reactions 14 Sep 1996 No. 6180114-9954/10/0618-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
