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