ACUTE TOXIC LEUKOENCEPHALOPATHY FOLLOWING STANDARD-DOSE CYTARABINE DURING INDUCTION THERAPY FOR PEDIATRIC ACUTE MYELOID LEUKEMIA PEDIATRIC CASE REPORT

Abstract

Background: Acute toxic leukoencephalopathy (ATL) is an uncommon but potentially reversible neurological complication of several chemotherapeutic agents, including cytarabine. Although neurotoxicity is well recognised with high-dose cytarabine, it is rarely reported following standard-dose induction therapy in children with acute myeloid leukemia (AML). Early recognition is important because timely supportive management can lead to complete neurological recovery. Keywords: Acute toxic leukoencephalopathy; Cytarabine; Acute myeloid leukemia; Pediatric oncology; Chemotherapy induced neurotoxicity; Magnetic resonance imaging; Encephalopathy; Standard-dose cytarabine. Case presentation: We report a 14-year-old boy with newly diagnosed AML who developed acute encephalopathy ten days after completing induction chemotherapy with standard-dose cytarabine and daunorubicin (7+3 regimen). He initially presented with fever, vomiting and loose stools, followed by altered sensorium and generalized weakness. Examination revealed a Glasgow Coma Scale score of 13/15, axial and truncal weakness, exaggerated deep tendon reflexes, bilateral ankle clonus and extensor plantar responses. Outcome: Brain MRI demonstrated multifocal diffusion restriction involving the bilateral deep white matter with corresponding T2/FLAIR hyperintensities, highly suggestive of acute toxic leukoencephalopathy. Cerebrospinal fluid examination, electroencephalography and microbiological investigations were unremarkable, making infective meningoencephalitis unlikely. The child improved completely with supportive care, treatment of febrile neutropenia and neuroprotective measures without any residual neurological deficit. Conclusion: This case highlights that cytarabine-induced toxic leukoencephalopathy may occur even with standard-dose therapy during pediatric AML induction. Prompt recognition of characteristic MRI findings and exclusion of alternative causes allow appropriate management and may prevent unnecessary interventions while improving neurological outcomes