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Open Access 01-12-2022 | Autopsy | Case report

Toxic leukoencephalopathy with axonal spheroids caused by chemotherapeutic drugs other than methotrexate

Authors: Ka Young Lim, Seong-Ik Kim, Hyunhee Kim, Jeongwan Kang, Jin Woo Park, Jae Kyung Won, Dong-Yeop Shin, Sung-Hye Park

Published in: BMC Neurology | Issue 1/2022

Abstract

Background

The objective of this report is to share the clinicopathological features of chemotherapy-induced toxic leukoencephalopathy, which is a rare and under-recognized disease, clinically characterized by rapidly progressive cognitive loss that often leads to sudden death.

Case presentation

A 64-year-old woman and a 63-year-old man, who had both suffered from a rapid deterioration of consciousness, were autopsied under the clinical impressions of either the central nervous system graft versus host disease (CNS-GVHD), infectious encephalitis, or autoimmune encephalitis. Both patients had been treated with multiple chemotherapy regimens, including adriamycin, cytarabine arabinoside, daunorubicin, fludarabine, azacitidine, and allogeneic peripheral blood stem cell transplantation to treat hematological malignancies (acute myelogenous leukemia and myelodysplastic syndrome). Neuropathological findings at autopsy revealed rarefaction and vacuolar changes of the white matter with axonal spheroids, reactive gliosis, and foamy macrophage infiltration, predominantly in the visual pathways of the occipital and temporal lobes. Damaged axons exhibited immunoreactivity to beta-amyloid, consistent with axonopathy. However, there was no lymphocyte infiltration that suggested CNS-GVHD or any type of encephalitis.

Conclusion

The neuropathology found in the presented cases had the characteristic features of toxic leukoencephalopathy (chemobrain). Our cases showed that toxic leukoencephalopathy can also be caused by chemotherapy drugs other than methotrexate.

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Title: Toxic leukoencephalopathy with axonal spheroids caused by chemotherapeutic drugs other than methotrexate
Authors: Ka Young Lim
Seong-Ik Kim
Hyunhee Kim
Jeongwan Kang
Jin Woo Park
Jae Kyung Won
Dong-Yeop Shin
Sung-Hye Park
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Autopsy
Methotrexate
Methotrexate
Autoimmune Encephalitis
Encephalopathy
Cytostatic Therapy
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-022-02818-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Toxic leukoencephalopathy with axonal spheroids caused by chemotherapeutic drugs other than methotrexate

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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