Cardiac arrest and possible seizure activity after vincristine injection

A case of cardiac arrest and possible seizure activity after vincristine injection in a child is reported.

A two-year-old African-American girl with stage IV hepatoblastoma arrived at a clinic to receive her fourth dose of vincristine as part of standard induction therapy. The patient had tolerated her first three doses of vincristine sulfate 0.7 mg (1.5 mg/m(2)) i.v. without any adverse events. Laboratory tests, including a comprehensive metabolic panel, conducted before chemotherapy administration were unremarkable. Shortly after the administration of vincristine, the patient experienced tonic extension of all four extremities and upward sustained deviation of the eyes. The patient then became limp and exhibited perioral cyanosis. Further evaluation revealed a lack of central pulses and a heartbeat. Cardiopulmonary resuscitation was begun with chest compressions and positive-pressure ventilation via a bag-mask device. After approximately 45 seconds, her pulses returned, and perioral cyanosis resolved. She was admitted to the pediatric intensive care unit for further evaluation. Her serum electrolyte, glucose, and ammonia concentrations were within normal limits. No yeast or bacteria were isolated from the patient's blood. No contributing cardiac or neurologic factors were identified. The patient recovered without sequelae and was discharged after 72 hours. Subsequent doses of vincristine were administered with no adverse events, and the patient successfully completed her treatment regimen.

A two-year-old girl with hepatoblastoma had seizurelike activity and cardiac arrest shortly after receiving i.v. vincristine. She received multiple doses of the drug before and after this event without a similar reaction. No contributing factors for the one-time event were identified.