Miyake K, Kamimura T, Gondo H, Okamura T, Niho Y
Kyushu University Graduate School of Medical Sciences.
Rinsho Ketsueki. 2000 Jul;41(7):585-90.
A 25-year-old woman with severe aplastic anemia received allogeneic bone marrow transplantation from an HLA-identical sibling. Pretransplant conditioning comprised 3.6 Gy of total body irradiation and 200 mg/kg cyclophosphamide. Cyclosporine (CSP) and methotrexate were administered to prevent graft-versus-host disease (GVHD). The patient complained of severe headache soon after CSP administration on day-1. On day 3, convulsion developed and she lost consciousness for 15 min. CT and MRI demonstrated low density areas and high signals, respectively, in the frontal and parietooccipital lobes and splenium of the corpus callosum, suggesting brain edema probably induced by CSP. After immediate withdrawal of CSP, glycerol and prednisolone were instituted, and the patient's condition improved. Thereafter, she developed grade II acute GVHD. This was treated with tacrolimus, which produced no adverse effects including central nervous system (CNS) toxicity. This case illustrates that careful management of CNS disorders induced by CSP can be important in patients undergoing allogeneic bone marrow transplantation.
一名25岁的重症再生障碍性贫血女性接受了来自HLA配型相同的同胞的异基因骨髓移植。移植前预处理包括3.6 Gy全身照射和200 mg/kg环磷酰胺。给予环孢素（CSP）和甲氨蝶呤以预防移植物抗宿主病（GVHD）。患者在第1天给予CSP后不久便主诉严重头痛。第3天，患者发生惊厥，意识丧失15分钟。CT和MRI分别显示额叶、顶枕叶及胼胝体压部出现低密度区和高信号，提示可能为CSP诱发的脑水肿。立即停用CSP后，给予甘油和泼尼松龙，患者病情好转。此后，她发生了Ⅱ级急性GVHD。使用他克莫司进行治疗，未产生包括中枢神经系统（CNS）毒性在内的不良反应。该病例表明，对于接受异基因骨髓移植的患者，谨慎处理由CSP诱发的中枢神经系统疾病可能很重要。
