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Eosinophilic meningitis triggered by implanted Gliadel wafers: case report
Kiyotaka Saito1, Kouji Yamasaki1, Kiyotaka Yokogami1
1Department of Neurosurgery, Division of Clinical Neuroscience, and.
Journal of Neurosurgery
|June 11, 2016
Summary
Carmustine (Gliadel) wafers can rarely cause eosinophilic meningitis due to the wafer matrix, polifeprosan. Immediate removal of Gliadel wafers is recommended if this rare adverse effect is suspected in glioma patients.
Area of Science:
- Neuro-oncology
- Neurology
- Allergy and Immunology
Background:
- Carmustine (Gliadel) wafers are used to treat malignant glioma, improving tumor control and survival.
- Despite benefits, adverse effects associated with Gliadel wafers have been reported.
Observation:
- A case of eosinophilic meningitis is reported in a patient following Gliadel wafer implantation for glioblastoma.
- The patient presented with headache, vomiting, and altered consciousness, with cerebrospinal fluid showing a high percentage of eosinophilic granulocytes.
Findings:
- Histological examination revealed eosinophilic granulocytes aggregated around the Gliadel wafers and in the brain parenchyma.
- Drug lymphocyte stimulation tests indicated that polifeprosan, the wafer matrix, elicited a positive reaction, suggesting it as the cause of the allergic response.
Implications:
- This case highlights the potential for polifeprosan in Gliadel wafers to trigger rare allergic reactions like eosinophilic meningitis.
- Immediate removal of Gliadel wafers should be considered in patients suspected of developing eosinophilic meningitis post-implantation.
Keywords:
BCNU = 1,3-bis(2-chloroethyl)-1-nitrosoureaDLST = drug lymphocyte stimulation testEG = eosinophilic granulocyteGliadel waferIgE = immunoglobulin EWBC = white blood celleosinophilic meningitishigh-grade gliomainfectiononcologyMore Related Videos
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