Conversion disorder with convulsion and motor deficit mimicking the adverse effects of high-dose Ara-C treatment in a posttransplant acute myeloid leukemia patient: a case report and review of the literature.
In this communication, we report an acute leukemia patient who developed conversion disorder mimicking the adverse effects of high-dose cytosine arabinoside (Ara-C) treatment after the patient received high-dose Ara-C treatment. A 21-year-old woman, with acute recurrent leukemia after bone marrow transplantation, received high-dose Ara-C treatment and 10 days later was referred for psychiatric consultation because of an abrupt onset of convulsion. On neurologic examination, she showed convulsion of all the limbs without loss of consciousness. All limbs looked paretic; however, tendon reflexes in all limbs were normal and pathological reflex was not recognized. When her hand was dropped onto her own face, it fell next to her face but not on her face. Laboratory data were unremarkable. She had no history of psychiatric illness or drug or alcohol abuse. The patient explained that she knew about the recurrence of her own leukemia and the news of the death of a close friend due to leukemia at the same time, which was a shocking event for her, focusing her attention on her own fears of dying from the same disease. Conversion disorder in cancer patients is not common; however, appropriate diagnosis is very important to avoid inappropriate examinations and treatments. In leukemia patients receiving chemotherapy, various kinds of signs and symptoms may develop due to the adverse effects of chemotherapy and/or infection. Therefore, conversion disorder might be overlooked and inappropriate treatment and examinations might be performed. Clinicians should consider conversion disorder in the differential diagnosis when patients develop unexplained neurological symptoms.
Onishi
Hideki
H
Department of Psychiatry, Kanagawa Prefecture Cancer Center, Yokohama, Japan. h-onishi@jg7.so-net.ne.jp
Kamijo
Aki
A
Onose
Masanari
M
Yamada
Tomoki
T
Mizuno
Yasuhiro
Y
Ito
Mizuho
M
Saito
Hideyuki
H
Maruta
Ichiro
I
D000208:Acute Disease; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D016026:Bone Marrow Transplantation; D003291:Conversion Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003561:Cytarabine / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000523:psychology* / Q000628:therapy; D020258:Neurotoxicity Syndromes / Q000175:diagnosis*; D011597:Psychomotor Performance; D012640:Seizures / Q000209:etiology
D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine