Ifosfamide Encephalopathy in A 4yr Old with Ewing’s Sarcoma by Edwin Dias in Progressing Aspects in Pediatrics and Neonatology in Lupinepublishers
Ifosfamide encephalopathy is a fatal toxicity of Ifosfamide therapy. 13 cases have been reported till the year of 2018 worldwide
in children and none among Ewing’s sarcoma cases. Here we are discussing a unique case of Ifosfamide encephalopathy during
the course of treatment of Ewing’s sarcoma and was on Ifosfamide therapy and developed encephalopathy. Child improved
symptomatically with MESNA and mannitol. Child was found to be normal on follow up and chemotherapy treatment was continued.Encephalopathy is a potentially fatal toxicity of Ifosfamide.
Clinical manifestation of encephalopathy range from fatigue and
confusion to coma and death. Early identification of this toxicity and
prompt cessation of Ifosfamide are the essential elements in the
management of Ifosfamide encephalopathy. Neurotoxicity has been
reported in about 5% children treated with Ifosfamide for tumour
not involving the CNS [1]. The entity of Ifosfamide neurotoxicity
can be of different degree, from very light and transient to fatal.
Neurotoxicity occurring during or immediately after Ifosfamide
infusion were recorded in children with both solid tumours or
leukemia. The drug was administered in different chemotherapeutic
association and dosage. Concomitant clinical conditions possibly
playing a role as risk factors were the administration of other
neurotoxic drugs, the presence of cerebral metastasis, a subclinical
lysis syndrome, and altered respiratory function. Symptoms were
transient and consisted in most cases, but some had partial or
generalised seizures. In some cases, the treatment was continued
substituting Ifosfamide with cyclophosphamide. Particularly in
patients presenting risk factors, attention has to be paid to the
risk of Ifosfamide neurotoxicity and rapidly suspend the drug
administration to avoid irreparable damage to the CNS.
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