Subacute central nervous system degeneration in a child: An unusual manifestation of ifosfamide intoxication

A 5-year-old child with desmoplastic small round-cell tumor was treated wit h a protocol of very-high-dose, short-term chemotherapy, containing HD-CAV (cyclophosphamide, doxorubicin, vincristine, and mesna), ifosfamide, and et oposide. Two days after the initiation of ifosfamide, he exhibited new-onse t lethal encephalopathy manifested by subacutely progressive cerebellar and then temporal and frontocortical degeneration leading to a vegetative stat e and eventually to death. A full work-up, including brain biopsy, was nega tive, excluding infections and metabolic or vascular causes. Ifosfamide is known to be capable of causing acute encephalopathy that can be severe but is generally reversible. This child showed avery atypical progressive, leth al course of ifosfamide toxicity. The possibility of this complication shou ld be considered when high-dose ifosfamide treatment is planned for childre n.