J Korean Med Sci.  1999 Feb;14(1):89-92. 10.3346/jkms.1999.14.1.89.

Behenoyl cytarabine-associated reversible encephalopathy in a patient with acute myelogenous leukemia

• Cho SG
• Moon H
• Lee JH
• Lee SY
• Kim CC
• Lee KS

• KMID: 1062204
• DOI: http://doi.org/10.3346/jkms.1999.14.1.89

Abstract

We report a case of reversible encephalopathy syndrome in a 16-year-old girl with acute myelogenous leukemia (AML), who is undergoing during consolidation chemotherapy composed of BH-AC (N4-behenoyl-1-beta-D-arabinofuranosyl cytosine) and idarubicin. On the 6th day of chemotherapy, she was in a drowsy state following generalized tonic clonic seizure lasting 20 minutes. MR images revealed extensive cortical and subcortical white matter brain edema. Alertness returned over the 24 hr following by the discontinuation of BH-AC and intravenous administration of diphenylhydantoin, although she complained of intermittent headaches and visual disturbance. She gradually recovered from these symptoms during subsequent 7 days. Previously noted abnormal signal intensities have nearly disappreared on follow-up MRI obtained on the 22nd day after the first seizure. She was discharged without any neurologic sequela. This case suggests that BH-AC, a derivative of cytosine arabinoside (1-beta-D-arabinofuranosylcytosine) could be a cause of reversible encephalopathy syndrome.

Keyword

Cytarabine; Brain edema; Drug toxicity; Leukemia, myelocytic, acute

MeSH Terms

Adolescence
Antineoplastic Agents/therapeutic use
Antineoplastic Agents/adverse effects*
Brain/radiography
Case Report
Cytarabine/therapeutic use
Cytarabine/analogs & derivatives*
Cytarabine/adverse effects
Female
Human
Leukemia, Myelocytic, Acute/drug therapy
Leukemia, Myelocytic, Acute/complications*
Magnetic Resonance Imaging
Seizures/radiography*
Seizures/chemically induced