Thalidomide
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First report of leukoencephalopathy: case report A 45-year-old woman developed reversible posterior lobe leukoencephalopathy during treatment with thalidomide for multiple myeloma. The woman started receiving thalidomide 200 mg/day plus dexamethasone on days 1–4, 9–12 and 17–20 on even cycles and days 1–4 on odd cycles; the cycles lasted 28 days. Thalidomide was increased to 300 mg/day for the third cycle. At the start of her fourth cycle, she had lower limb sensory symptoms with no evidence of motor weakness, suggesting a thalidomide peripheral nerve disorder. Thalidomide was decreased to 200 mg/day and, 7 days later, the woman presented with subacute near total vision loss. Her loss of vision was painless, and had decreased to light perception only, overnight. Otherwise, she had symptomatic improvement in her peripheral nerve disorder. Retrobulbar neuritis was suspected. A brain and orbit CT scan showed bilateral hypodense white matter lesions of her occipital lobes, and an MRI revealed irregular bilateral lesions in her occipital lobes which were hyperintense on T2-weighted sequences; these findings were suggestive of leukoencephalopathy. She received IV dexamethasone every 8 hours. Her vision was 50% of normal by day 3 of corticosteroid treatment. By day 7, almost 100% of her vision had recovered. Repeat MRI revealed disappearance of almost all of her white matter lesion with a very small lesion remaining. Thalidomide was stopped, and melphalan and prednisolone were started. At last follow-up, she was healthy on maintenance corticosteroids. Author comment: "The immunosuppressive effect or an unrecognized effect of thalidomide on endothelial cells causing alteration in the balance of vasoconstrictor and vasodilator prostaglandins may have caused this syndrome." Pandey R, et al. A rare complication in a case of multiple myeloma on therapy with thalidomide and dexamethasone - reversible posterior lobe leukoencephalopathy. Leukemia and Lymphoma 47: 1431-1434, No. 7, Jul 2006 801047334 India
» Editorial comment: A search of AdisBase and Medline revealed no previous cases of leukoencephalopathy associated with thalidomide. The WHO Adverse Drug Reactions Database contained 21 reports of encephalopathy associated with thalidomide.
0114-9954/10/1124-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 21 Oct 2006 No. 1124
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