Encephalopathy with parkinsonian features in children following bone marrow transplantations and high-dose amphotericin B

• Published in: Annals of neurology Vol. 37; no. 6; p. 810
• Main Authors: Mott, S H, Packer, R J, Vezina, L G, Kapur, S, Dinndorf, P A, Conry, J A, Pranzatelli, M R, Quinones, R R
• Format: Journal Article
• Language: English
• Published: United States 01-06-1995
• Subjects: Adolescent; Amphotericin B - administration & dosage; Amphotericin B - adverse effects; Antineoplastic Agents - adverse effects; Aspergillosis - drug therapy; Bone Marrow Transplantation; Brain Diseases - etiology; Brain Diseases - pathology; Child; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Humans; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - radiotherapy; Leukemia, Myeloid, Acute - surgery; Leukemia, Myeloid, Acute - therapy; Lung Diseases - drug therapy; Male; Methotrexate - administration & dosage; Parkinson Disease - etiology; Radiation Injuries
• ISSN: 0364-5134
• DOI: 10.1002/ana.410370616

Encephalopathy, leukoencephalopathy, and secondary parkinsonism occurred in 3 children with refractory leukemia undergoing allogenic bone marrow transplantation (BMT) who were treated with high-dose amphotericin B for pulmonary aspergillosis or sinus aspergillosis that did not involve the nervous system. Treatment included high-dose cytosine arabinoside, cyclophosphamide, and total body irradiation prior to the BMT. The children developed a progressively worsening encephalopathy and parkinsonian features, characterized by resting tremor, cogwheel rigidity, and masklike facies. Neuroimaging studies showed cerebellar, cerebral, and basal ganglia atrophy, as well as frontal and temporal lobe white matter involvement. Two of the 3 patients recovered, although 1 has residual intellectual impairment. The third succumbed to non-central nervous system Epstein-Barr virus-lymphoproliferative disease and had autopsy-confirmed leukoenephalopathy.