Central pontine myelinolysis in a patient with acute lymphoblastic leukemia after hematopoietic stem cell transplantation: a case report.
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.
Lim
Kyu-Hyoung
KH
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul, Korea.
Kim
Sunyoung
S
Lee
Yoon-Su
YS
Kim
Ki Hwan
KH
Kim
Jinwon
J
Rhee
Ji young
Jy
Kim
Hye Jin
HJ
Yi
Hyeon Gyu
HG
Oh
So Yeon
SY
Lim
Joo Han
JH
Han
Sae-Won
SW
Lee
Sangyoon
S
Kim
Inho
I
Yoon
Sung-Soo
SS
Park
Seonyang
S
Kim
Byoung Kook
BK
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