Cho S G, Moon H, Lee J H, Lee S Y, Kim C C, Lee K S
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.
J Korean Med Sci. 1999 Feb;14(1):89-92. doi: 10.3346/jkms.1999.14.1.89.
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.
我们报告了一例16岁急性髓性白血病（AML）女孩发生可逆性脑病综合征的病例，该女孩正在接受由BH-AC（N4-山嵛酰-1-β-D-阿拉伯呋喃糖基胞嘧啶）和伊达比星组成的巩固化疗。化疗第6天，在持续20分钟的全身性强直阵挛发作后，她处于嗜睡状态。磁共振成像（MR）显示广泛的皮质和皮质下白质脑水肿。停用BH-AC并静脉注射苯妥英钠后，在接下来的24小时内她恢复了清醒，尽管她仍诉说间歇性头痛和视觉障碍。在随后的7天里，她逐渐从这些症状中恢复。首次发作后第22天进行的随访磁共振成像显示，之前发现的异常信号强度几乎消失。她出院时没有任何神经后遗症。该病例表明，阿糖胞苷（1-β-D-阿拉伯呋喃糖基胞嘧啶）的衍生物BH-AC可能是可逆性脑病综合征的一个病因。
