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Encephalopathy with parkinsonian features in children following bone marrow transplantations and high‐dose amphotericin B
Author(s) -
Mott Stephen H.,
Packer Roger J.,
Vezina L. Gilbert,
Kapur Sudesh,
Dinndorf Patricia A.,
Conry Joan A.,
Pranzatelli Michael R.,
Quis Ralph R.
Publication year - 1995
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410370616
Subject(s) - leukoencephalopathy , medicine , encephalopathy , parkinsonism , total body irradiation , pathology , cytarabine , progressive multifocal leukoencephalopathy , amphotericin b , leukemia , cyclophosphamide , chemotherapy , disease , immunology , dermatology , multiple sclerosis , antifungal
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.