title: A Case of Subacute Encephalopathy Developing After Treatment With Clofarabine and Methotrexate That Resolved With Corticosteroids.
abstract: This is the case of a 24-year-old woman with relapsed acute undifferentiated leukemia who developed subacute encephalopathy with hemiparesis and dysarthria after treatment with high dose and intrathecal methotrexate, clofarabine, and cytarabine that resolved rapidly and completely after the administration of corticosteroids. We hypothesize that clofarabine might predispose to methotrexate-induced central nervous system toxicity by increasing endothelial permeability (capillary leak syndrome) and suggest that corticosteroids are effective in the treatment of this type of encephalopathy.
authors.affiliation: 1Division of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA; 2Department of Internal Medicine, University of Southern California, Los Angeles, CA; and 3Department of Pharmacology and Clinical Pharmacology, Aristotelian University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tzachanis
authors.forename: Mintallah
authors.initials: M
authors.lastname: Haider
authors.forename: Georgios
authors.initials: G
authors.lastname: Papazisis
mesh_terms: D000227:Adenine Nucleotides / Q000008:administration & dosage / Q000009:adverse effects*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001087:Arabinonucleosides / Q000008:administration & dosage / Q000009:adverse effects*; D000077866:Clofarabine; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007938:Leukemia / Q000188:drug therapy; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008775:Methylprednisolone / Q000627:therapeutic use*; D020258:Neurotoxicity Syndromes / Q000188:drug therapy / Q000209:etiology*; D055815:Young Adult
chemical_list: D000227:Adenine Nucleotides; D000305:Adrenal Cortex Hormones; D001087:Arabinonucleosides; D003561:Cytarabine; D000077866:Clofarabine; D008775:Methylprednisolone; D008727:Methotrexate