Multifocal central nervous system demyelination and Lhermitte's phenomenon secondary to combination chemotherapy for chronic lymphocytic leukaemia.
The CRF regime (cyclophosphamide, rituximab and fludarabine) is used for the treatment of chronic lymphocytic leukaemia. We report a case of diffuse CNS demyelination following treatment with CRF, presenting with Lhermitte's phenomenon, and imaging and neurophysiological evidence of demyelination. Fludarabine is the most likely causative agent, although CNS demyelination has not been previously described in low dose therapy.
Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; The University of Sydney, NSW 2006, Australia.
J
J
Hafner
Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; The University of Sydney, NSW 2006, Australia.
K
K
Kumar
Department of Haematology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; The University of Sydney, NSW 2006, Australia.
S
S
Mulligan
Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; The University of Sydney, NSW 2006, Australia. Electronic address: karl.ng@sydney.edu.au.
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Ng
D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects; D006223:Hamartoma Syndrome, Multiple / Q000139:chemically induced*; D020279:Hereditary Central Nervous System Demyelinating Diseases / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000139:chemically induced*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives
D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine
Chemotherapy; Chronic lymphocytic leukaemia; Demyelination; Evoked response; Fludarabine; Lhermitte's sign