Eosinophilic meningitis triggered by implanted Gliadel wafers: case report.
Although carmustine (Gliadel) wafers improve local tumor control and extend the overall survival in patients with malignant glioma, adverse effects have been documented. The authors report the first case of eosinophilic meningitis triggered by the placement of Gliadel wafers. A 61-year-old man with a history of alimentary allergy and glioblastoma in the right frontal lobe underwent resection followed by the implantation of Gliadel wafers. Three weeks later he suffered the sudden onset of headache, vomiting, and progressive consciousness disturbance. Computed tomography revealed enlargement of the ventricular system and subdural space on the side of the tumor. His CSF leukocyte count increased up to 3990 cells/mm3; 95% of the cells were eosinophilic granulocytes (EGs), suggesting eosinophilic meningitis. Laboratory examination showed the patient to have various elevated allergy indicators. The administration of corticosteroids failed to improve his condition. Despite the insertion of a lumbar drain his symptoms failed to improve. He underwent a second surgical intervention to remove the Gliadel wafers. Histologically, EGs had assembled around the wafers. Eosinophilic infiltrate was present in the brain parenchyma around small vessels. After ventriculoperitoneal shunting his course was favorable. A drug lymphocyte stimulation test against the Gliadel wafers failed to demonstrate a positive reaction; polifeprosan, the wafer matrix without 1,3-bis(2-chloroethyl)-1-nitrosourea, yielded a positive reaction. These findings strongly suggest that although extremely rare, polifeprosan (the wafer matrix) can elicit an allergic reaction. When eosinophilic meningitis is suspected after the implantation of Gliadel wafers, their immediate removal should be considered.
Department of Neurosurgery, Division of Clinical Neuroscience, and.
Kiyotaka
K
Saito
Department of Neurosurgery, Division of Clinical Neuroscience, and.
Kouji
K
Yamasaki
Department of Neurosurgery, Division of Clinical Neuroscience, and.
Kiyotaka
K
Yokogami
Department of Neurosurgery, Division of Clinical Neuroscience, and.
Asya
A
Ivanova
Department of Neurosurgery, Division of Clinical Neuroscience, and.
Go
G
Takeishi
Department of Diagnostic Pathology, Miyazaki University Hospital, Faculty of Medicine, University of Miyazaki, Japan.
Yuichiro
Y
Sato
Department of Neurosurgery, Division of Clinical Neuroscience, and.
Hideo
H
Takeshima
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001921:Brain / Q000000981:diagnostic imaging*; D001932:Brain Neoplasms / Q000188:drug therapy*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects*; D003652:Decanoic Acids / Q000008:administration & dosage / Q000009:adverse effects*; D016503:Drug Delivery Systems / Q000009:adverse effects; D004343:Drug Implants; D004802:Eosinophilia / Q000000981:diagnostic imaging / Q000209:etiology*; D005910:Glioma / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008581:Meningitis / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D011091:Polyesters / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D003652:Decanoic Acids; D004343:Drug Implants; D011091:Polyesters; C574855:carmustine, poliferprosan 20 drug combination; D002330:Carmustine
BCNU = 1,3-bis(2-chloroethyl)-1-nitrosourea; DLST = drug lymphocyte stimulation test; EG = eosinophilic granulocyte; Gliadel wafer; IgE = immunoglobulin E; WBC = white blood cell; eosinophilic meningitis; high-grade glioma; infection; oncology