Severe Reversible Form of Chemotherapy Induced Acute Disseminated Leukoencephalopathy: A Case Report with Review of Literature

Abstract

Leuko-encephalopathy is a disease of the white matter of the brain occurring as a result of various exogenous and endogenous causes. It is one rare, but important cause being use of chemotherapeutic agents. Neurological manifestations are numerous with varying severity. Radiological features are characteristic of leukoencephalopathy well depicted on magnetic resonance imaging (MRI). Here the authors describe case of a gentleman with carcinoma rectum undergoing chemotherapy (5 fluorouracil and oxaliplatin) during which he developed severe encephalopathy with akinetic rigid state. MRI features were characteristic and there was complete clinical recovery and radiological resolution on stopping the causative agent.

FOLFIRI-bevacizumab-induced acute toxic leukoencephalopathy

“…There is no literature exploring this question, but it has been reported that ATL development might be dose-dependent. 7 The previous studies state that median time to development of symptoms after 5-FU infusion is 3 days, in our case, it was 4 days. 2 Irinotecan might cause ATL as well, because it is given as a FOLFIRI regimen, it is difficult to know which drug is the causative agent for ATL.…”

“…There is no literature exploring this question, but it has been reported that ATL development might be dose-dependent. 7 The previous studies state that median time to development of symptoms after 5-FU infusion is 3 days, in our case, it was 4 days. 2…”

“…The cessation of the possible causative agent is essential. 7 There are reports where rechallenges with 5-FU with dose reduction caused ATL. 8 On the other hand, for some cases initiation of capecitabine, an oral fluoropyrimidine, after the history of ATL with 5-FU did not cause any symptoms.…”