Fatal myeloencephalopathy due to accidental intrathecal vincristin administration: a report of two cases

We report on two fatal cases of accidental intrathecal vincristine instilla tion in a 5-year old girl with recurrent acute lymphoblastic leucemia and a 57-year old man with lymphoblastic lymphoma. The girl died seven days, the man four weeks after intrathecal injection of vincristine. Clinically. the onset was characterized by the signs of opistothonus, sensory and motor dy sfunction and ascending paralysis. Histological and immunohistochemical inv estigations (HE-LFB. CD-68. Neurofilament) revealed degeneration of myelin and axons as well as pseudocystic transformation in areas exposed to vincri stine, accompanied by secondary changes with numerous prominent macrophages . The clinical course and histopathological results of the two cases are pr esented. A review of all reported cases in the literature is given. A bette r controlled regimen for administering vincristine and intrathecal chemothe rapy is recommended. (C) 2001 Elsevier Science Ireland Ltd. All rights rese rved.