Antineoplastics/corticosteroids
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Reactions 699 - 2 May 1998 S Antineoplastics/corticosteroids Fatal leucoencephalopathy: case report Fatal leucoencephalopathy occurred in a 56-year-old woman with non-Hodgkin’s lymphoma following treatment with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), followed by stress doses of hydrocortisone. On hospital day 3, the woman was treated with IV cyclophosphamide 750 mg/m 2 , doxorubicin 50 mg/m 2 , vincristine 1.4 mg/m 2 and oral prednisone 100mg (CHOP) for 5 days. On day 8, she developed neutropenia and was treated with granulocyte colony-simulating factor, tazobactam- piperacillin and IV hydrocortisone 100mg every 8 hours. On day 10, she had a tonic-clonic seizure associated with confusion, blurred vision and a decreased level of consciousness. A CT brain scan showed subtle bilateral occipital hypondense areas. On day 15, the woman developed a dense right hemiparesis with right-sided hyper-reflexia. A repeat CT scan showed progression of the hypodense areas to involve the subcortical white matter. Haematological recovery occurred on day 17 and granulocyte colony-stimulating factor and antibacterial therapy were discontinued. However, her neurological status deteriorated and her coma deepened. She died on day 19. Post-mortem brain examination showed diffuse white matter oedema with small areas of perivascular haemorrhage; the left cerebral hemisphere was more severely affected. Author comment: ‘The use of high-dose steroids without concomitant use of other immunosuppressives such as cyclosprine has never been implicated as a cause of leukoencephalopathy. The etiology of the leukoencephalopathy in this patient was likely multifactorial. This is the first case of a fatal leukoencephalopathy syndrome described in a patient receiving standard CHOP chemotherapy for NHL [non-Hodgkin’s lymphoma], and may be related to administration of high-dose steroids in combination with immunosuppressive chemotherapy.’ Cain MS, et al. Fatal leukoencephalopathy in a patient with non-Hodgkin’s lymphoma treated with CHOP chemotherapy and high-dose steroids. American Journal of the Medical Sciences 315: 202-207, Mar 1998 - USA 800659569 1 Reactions 2 May 1998 No. 699 0114-9954/10/0699-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics/corticosteroids
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
