Behenoyl cytarabine-associated reversible encephalopathy in a patient withacute myelogenous leukemia

We report a case of reversible encephalopathy syndrome in a 16-year-old gir l with acute myelogenous leukemia (AML), who is undergoing during consolida tion chemotherapy composed of BH-AC (N-4-behenoyl-1-beta-D-arabinofuranosyl cytosine) and idarubicin. On the 6th day of chemotherapy, she was in a dro wsy state following generalized tonic clonic seizure lasting 20 minutes. MR images revealed extensive cortical and subcortical white matter brain edem a. Alertness returned over the 24 hr following by the discontinuation of BH -AC and intravenous administration of diphenylhydantoin, although she compl ained of intermittent headaches and visual disturbance. She gradually recov ered from these symptoms during subsequent 7 days. Previously noted abnorma l signal intensities have nearly disappreared on follow-up MRI obtained on the 22nd day after the first seizure. She was discharged without any neurol ogic sequela. This case suggests that BH-AC, a derivative of cytosine arabi noside (1-beta-D-arabinofuranosylcytosine) could be a cause of reversible e ncephalopathy syndrome.