title: Encephalopathy following melphalan administration.
abstract: OBJECTIVE
  To describe a rare case of encephalopathy following melphalan administration. Presentation and intervention:: A 59-year-old female with multiple myeloma developed encephalopathy following administration of melphalan. After ruling out other aetiologies, we hypothesized elevated cytokines from systemic inflammatory response to melphalan as the likely aetiology. The TNF-alpha level was found to be significantly elevated. Plasmapharesis was performed which reduced the level of cytokines, and also improved the patient's neurological status.
  
  
  CONCLUSIONS
  Melphalan administration, especially in renally impaired patients, may lead to development of encephalopathy. Based on our case report, we suggest that elevated levels of cytokines could be the underlying mechanism of worsening mental status.
authors.affiliation: a Department of Neurology , University of Texas South Western Medical Center , Dallas , TX , USA.
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Dubey
authors.affiliation: a Department of Neurology , University of Texas South Western Medical Center , Dallas , TX , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Freeman
authors.affiliation: b University of Texas South Western Medical Center , Dallas , TX , USA.
authors.forename: Om James
authors.initials: OJ
authors.lastname: Neeley
authors.affiliation: a Department of Neurology , University of Texas South Western Medical Center , Dallas , TX , USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
mesh_terms: D016026:Bone Marrow Transplantation; D001928:Brain Diseases, Metabolic / Q000139:chemically induced* / Q000628:therapy; D005260:Female; D006801:Humans; D008558:Melphalan / Q000009:adverse effects*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D019653:Myeloablative Agonists / Q000009:adverse effects*; D010956:Plasmapheresis; D019172:Transplantation Conditioning / Q000009:adverse effects
chemical_list: D019653:Myeloablative Agonists; D008558:Melphalan
keywords: Cytokines; Dialysis; Encephalopathy; Melphalan; Multiple myeloma; Plasmapharesis; Renal failure; Tumour necrosis factor-alpha