Subacute central nervous system degeneration in a child: an unusual manifestation of ifosfamide intoxication.
A 5-year-old child with desmoplastic small round-cell tumor was treated with a protocol of very-high-dose, short-term chemotherapy, containing HD-CAV (cyclophosphamide, doxorubicin, vincristine, and mesna), ifosfamide, and etoposide. Two days after the initiation of ifosfamide, he exhibited new-onset lethal encephalopathy manifested by subacutely progressive cerebellar and then temporal and frontocortical degeneration leading to a vegetative state and eventually to death. A full work-up, including brain biopsy, was negative, excluding infections and metabolic or vascular causes. Ifosfamide is known to be capable of causing acute encephalopathy that can be severe but is generally reversible. This child showed a very atypical progressive, lethal course of ifosfamide toxicity. The possibility of this complication should be considered when high-dose ifosfamide treatment is planned for children.
Pediatric Hematology-Oncology Institute, Schneider Children's Medical Center of Israel, Petah Tiqva. icohen@ccsg/tau.ac.il
A
A
Shuper
J
J
Stein
J
J
Goshen
L
L
Kornreich
I
I
Yaniv
I J
IJ
Cohen
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D002531:Cerebellum / Q000187:drug effects* / Q000473:pathology; D002540:Cerebral Cortex / Q000187:drug effects* / Q000473:pathology; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D017809:Fatal Outcome; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009410:Nerve Degeneration / Q000139:chemically induced* / Q000473:pathology; D018458:Persistent Vegetative State / Q000139:chemically induced* / Q000473:pathology
D007069:Ifosfamide