Severe neurotoxicities in a case of Charcot-Marie-Tooth disease type 2 caused by vincristine for acute lymphoblastic leukemia.
We report a 13-year-old male patient with Charcot-Marie-Tooth disease (CMT) type 2 who developed severe neuropathy because of vincristine (VCR) for his acute lymphoblastic leukemia. A clumsy gait, muscle weakness in his fingers, and inverted champagne bottlelike muscle in the lower limbs were noticed after remission induction treatment for acute lymphoblastic leukemia, which included VCR at a total dose of 8 mg/m. An electrophysiologic study showed an almost normal median motor nerve conduction velocity (approximately 50 m/s), markedly reduced M-wave amplitude and sensory disturbance. He was diagnosed as CMT type 2 based on his symptoms and electrophysiologic findings. His symptoms gradually worsened, and even after VCR was discontinued, he could not walk alone for 7 months. VCR has previously been considered to be relatively safe in CMT type 2, however, some patients with CMT type 2 might show severe neurologic toxicities, as seen in patients with CMT type 1.
Nishikawa
Takuro
T
Department of Pediatrics, Kagoshima City Hospital, Kagoshima University Graduate School of Medical, Kagoshima, Japan. adu44150@ams.odn.ne.jp
Kawakami
Kiyoshi
K
Kumamoto
Takashi
T
Tonooka
Shiro
S
Abe
Akiko
A
Hayasaka
Kiyoshi
K
Okamoto
Yasuhiro
Y
Kawano
Yoshifumi
Y
D000293:Adolescent; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage; D002607:Charcot-Marie-Tooth Disease / Q000150:complications* / Q000175:diagnosis; D000075202:Contraindications; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D020233:Gait Disorders, Neurologic / Q000139:chemically induced* / Q000209:etiology; D006801:Humans; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D018908:Muscle Weakness / Q000139:chemically induced / Q000209:etiology; D009431:Neural Conduction / Q000187:drug effects; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000209:etiology; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage; D012074:Remission Induction; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects*
D000972:Antineoplastic Agents, Phytogenic; D003561:Cytarabine; D014750:Vincristine; D005047:Etoposide; D011239:Prednisolone; D015122:Mercaptopurine; D001215:Asparaginase; D008727:Methotrexate; D003630:Daunorubicin