title: Central pontine myelinolysis in a patient with acute lymphoblastic leukemia after hematopoietic stem cell transplantation: a case report.
abstract: We describe a 37-yr-old man who developed central pontine myelinolysis (CPM) after allogeneic hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia. After HSCT, desquamation developed on the whole body accompanied by hyperbilirubinemia. The liver biopsy of the patient indicated graft-versus-host disease- related liver disease, and the dose of methylprednisolone was increased. Then, the patient developed altered mentality with eye ball deviation to the left, for which electroencephalogram and magnetic resonance imaging (MRI) scans were done. Brain MRI scan demonstrated the imaging findings consistent with central pontine myelinolysis and extrapontine myelinolysis. He did not have any hyponatremia episode during hospitalization prior to the MRI scan. To the best of our knowledge, presentation of CPM after allogeneic HSCT is extremely rare in cases where patients have not exhibited any episodes of significant hyponatremia. We report a rare case in which hepatic dysfunction due to graft-versus-host disease has a strong association with CPM after HSCT.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul, Korea.
authors.forename: Kyu-Hyoung
authors.initials: KH
authors.lastname: Lim
authors.forename: Sunyoung
authors.initials: S
authors.lastname: Kim
authors.forename: Yoon-Su
authors.initials: YS
authors.lastname: Lee
authors.forename: Ki Hwan
authors.initials: KH
authors.lastname: Kim
authors.forename: Jinwon
authors.initials: J
authors.lastname: Kim
authors.forename: Ji young
authors.initials: Jy
authors.lastname: Rhee
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Hyeon Gyu
authors.initials: HG
authors.lastname: Yi
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Oh
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Lim
authors.forename: Sae-Won
authors.initials: SW
authors.lastname: Han
authors.forename: Sangyoon
authors.initials: S
authors.lastname: Lee
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.forename: Seonyang
authors.initials: S
authors.lastname: Park
authors.forename: Byoung Kook
authors.initials: BK
authors.lastname: Kim
mesh_terms: D000328:Adult; D001706:Biopsy; D001921:Brain / Q000473:pathology; D004569:Electroencephalography; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D017590:Myelinolysis, Central Pontine / Q000150:complications / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome