title: Successful treatment of ifosfamide neurotoxicity with dexmedetomidine.
abstract: Neurotoxicity related to the use of ifosfamide is a well-known complication. While the use of methylene blue is a known antidote, symptomatic treatment of the central nervous system (CNS) effects can be challenging. We present a case of class IV neurotoxicity with the successful treatment of symptomology. In this case report we present a 2-year-old female with relapsed alveolar rhabdomyosarcoma undergoing palliative chemotherapy. Patient received ifosfamide in addition to etoposide and mesna. The patient developed acute hallucinations, agitation, and delirium. The patient was transferred to the pediatric intensive care unit where she was administered dexmedetomidine overnight in addition to methylene blue. The patient awoke the next morning following discontinuation of the dexmedetomidine infustion and subsequently had no further central nervous system effects. This case demonstrates the novel use of an alpha-2 agonist in the treatment of neurotoxicity related to ifosfamide administration.
authors.affiliation: Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY 40536, USA. philip.bernard@uky.edu
authors.forename: Philip A
authors.initials: PA
authors.lastname: Bernard
authors.forename: Tara
authors.initials: T
authors.lastname: McCabe
authors.forename: Sherry
authors.initials: S
authors.lastname: Bayliff
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D000931:Antidotes / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects* / Q000627:therapeutic use; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007069:Ifosfamide / Q000009:adverse effects* / Q000627:therapeutic use; D008751:Methylene Blue / Q000627:therapeutic use; D020258:Neurotoxicity Syndromes / Q000188:drug therapy*; D012208:Rhabdomyosarcoma / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D000931:Antidotes; D018906:Antineoplastic Agents, Alkylating; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008751:Methylene Blue; D007069:Ifosfamide