title: Hearing loss during osteosarcoma chemotherapy: when acute ifosfamide toxicity revealed unnoticed methotrexate encephalopathy.
abstract: Ifosfamide and methotrexate are widely used for the treatment of pediatric osteosarcoma. However, both these chemotherapeutic drugs can cause encephalopathy. A 17-year-old girl presented with profound hearing loss and dizziness during a postoperative course of ifosfamide, 20 days after a course of methotrexate. Cerebral magnetic resonance imaging (MRI) showed bilateral white matter hypersignal in Fluid Attenuated Inversion Recovery sequences. The clinical evolution was rapidly favorable after methylene blue infusion. This is the second reported case of acute deafness, possibly associated with ifosfamide, whereas MRI data revealed unnoticed chronic methotrexate toxicity. Systematic MRI screening and hearing evaluation may be useful in such cases.
authors.affiliation: Departments of *Pediatric Oncology †Radiology, CHU Rennes ‡CNRS IGDR UMR 6290, Institut Génétique et Développement de Rennes §Université Rennes 1, UEB, IFR 140, Medical University, Rennes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Robert
authors.forename: Céline
authors.initials: C
authors.lastname: Chappé
authors.forename: Sophie
authors.initials: S
authors.lastname: Taque
authors.forename: Bertrand
authors.initials: B
authors.lastname: Bruneau
authors.forename: Virginie
authors.initials: V
authors.lastname: Gandemer
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy*; D001921:Brain / Q000187:drug effects / Q000473:pathology; D001927:Brain Diseases / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D034381:Hearing Loss / Q000139:chemically induced*; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000009:adverse effects; D012516:Osteosarcoma / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D007069:Ifosfamide; D008727:Methotrexate