title: L-asparaginase fatal toxic encephalopathy during consolidation treatment in an adult with acute lymphoblastic leukemia.
abstract: METHODS
  Male, 51 FINAL DIAGNOSIS: Encephalopaty toxic Symptoms: Confusion • disorientation • drowsiness • fever
  
  
  METHODS
  L-asparaginase Clinical Procedure: - Specialty: Oncology.
  
  
  OBJECTIVE
  Unknown ethiology.
  
  
  BACKGROUND
  Novel therapies have improved survival in malignancies of lymphoid origin. This improvement, however, has been at the cost of chemotherapy-related toxicities. L-asparaginase is frequently included in combination chemotherapies for acute lymphoblastic leukemia. Its use is frequently limited by significant adverse effects, such as coagulation abnormalities and cerebrovascular complications. L-asparaginase-associated encephalopathy is most often observed during the induction phase of chemotherapy and usually carries a favorable prognosis.
  
  
  METHODS
  We describe the profile of an adult with acute lymphoblastic leukemia treated with L-asparaginase, who developed toxic leukoencephalopathy during the second phase of consolidation treatment. He presented with decreased level of consciousness, which progressed to deep coma and finally brain death. MRI disclosed extensive lesions, consistent with toxic encephalopathy.
  
  
  CONCLUSIONS
  Even mild neurological symptoms should raise suspicion of these possibly fatal chemotherapy related toxicities.
authors: 2 Department of Critical Care, University Hospital Attikon, Athens, Greece.
authors: Frantzeska
authors: F
authors: Frantzeskaki
authors: Michalis
authors: M
authors: Rizos
authors: Matilda
authors: M
authors: Papathanassiou
authors: Nikitas
authors: N
authors: Nikitas
authors: Maria
authors: M
authors: Lerikou
authors: Apostolos
authors: A
authors: Armaganidis
authors: George
authors: G
authors: Dimopoulos
keywords: L-asparaginase; leukemia; toxic encephalopathy
references: Mod Pathol. 2004 Feb;17(2):241-7
references: 14704718
references: Acta Paediatr Scand. 1990 Mar;79(3):335-42
references: 2333748
references: Semin Oncol. 1985 Jun;12(2):122-30
references: 3859923
references: J Pediatr Hematol Oncol. 2003 Jun;25(6):484-7
references: 12794528
references: Klin Padiatr. 1994 Jul-Aug;206(4):334-41
references: 7967435
references: Cancer. 1981 Oct 15;48(8):1724-37
references: 6793225
references: Cancer Res. 1970 Sep;30(9):2297-305
references: 4920133
references: AJNR Am J Neuroradiol. 1996 Feb;17(2):295-310
references: 8938302
references: AJR Am J Roentgenol. 2009 Jul;193(1):192-206
references: 19542414
references: Leukemia. 1998 May;12(5):660-5
references: 9593262
references: Neurology. 1969 Apr;19(4):367-74
references: 5813374
references: AJNR Am J Neuroradiol. 2010 Sep;31(8):1471-9
references: 20448015
references: J Clin Oncol. 1994 Mar;12(3):627-42
references: 8120563
references: Cancer Chemother Pharmacol. 1993;32(4):310-4
references: 8324873
references: Neurol Sci. 2008 Jun;29(3):131-7
references: 18612759