COEXISTENCE OF LIFE-THREATENING CHEMOTHERAPY-RELATED LEUKOENCEPHALOPATHY, SAGGITAL SINUS THROMBOSIS AND MULTIPLE ORGAN FAILURE IN A CHILD WITH ACUTE LYMPHOBLASTIC-LEUKEMIA - AN UNUSUAL CASE WITH CLINICAL RECOVERY

A nine-year old girl with T cell acute lymphoblastic leukemia (ALL) ha d acute severe neurologic complications at the end of the remission-in duction chemotherapy course. Thirty-six hours following triple intrath ecal (IT) therapy and intravenous (IV) administration of L-asparaginas e (L-asp), tetraplegia developed and she became unconscious. She had b outs of hypertension and persistent tachycardia unresponsive to digita lis therapy. Magnetic resonance imaging (MRI) showed multiple brain wh ite matter hyperintensities and filling defects in the saggital sinus, suggesting thrombosis. Over the 40 days, in addition to her neurologi c compromise she also had transient diabetes mellitus, severe hyperlip idemia, hypoproteinemia and edema, liver and heart failure and staphyl ococcus aureus sepsis with prolonged bone marrow depression. Despite, coexistence of all these chemotherapy related complications, her neuro logic functions and multiple organ failure improved gradually. After a 70 days' period of interruption, chemotherapy was resumed and continu ed without any further complications. Although, the etiology of her ex tensive sensitivity to some drugs remains unclear, we believe that it is important to document these unusual events in this child.