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Ascending myeloencephalopathy due to intrathecal vincristine sulfate. A fatal chemotherapeutic error
Abstract:
A case of fatal myeloencephalopathy secondary to accidental intrathecal administration of vincristine is reported in a 16-year-old boy. He underwent a progressive ascending chemical meningoencephalitis leading to coma, and died 36 days after the injection. Multiple samples of cerebrospinal fluid (CSF) and serum were assayed for vincristine sulfate. CSF levels of vincristine were consistently much higher than serum levels. At autopsy, all regions of the brain that had been in direct contact with the CSF were necrotic. The spinal cord was likewise necrotic throughout its length. Microscopically there was total neuronal loss with tissue destruction in the affected regions. The presence of numerous gemistocytic astrocytes, some in arrested mitosis, was a conspicuous feature in these areas. Three previous reports of intrathecal vincristine instillation are reviewed. No treatment for this devastating iatrogenic error exists, underscoring the importance of preventive measures in chemotherapy administration.
Insights
Accidental intrathecal vincristine administration caused fatal myeloencephalopathy in a teenage boy, leading to coma and death. High cerebrospinal fluid (CSF) vincristine levels and brain necrosis highlight the severe toxicity of this chemotherapy error.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Vincristine is a chemotherapy agent used to treat various cancers.
- Intrathecal administration bypasses the blood-brain barrier, potentially increasing central nervous system toxicity.
- Accidental intrathecal vincristine administration is a rare but devastating iatrogenic event.
Purpose of the Study:
- To report a fatal case of myeloencephalopathy following accidental intrathecal vincristine administration.
- To analyze cerebrospinal fluid (CSF) and serum vincristine levels in this case.
- To review previous cases and emphasize preventive strategies.
Main Methods:
- Case report of a 16-year-old male patient.
- Serial sampling and assay of CSF and serum for vincristine sulfate.
- Autopsy and histopathological examination of brain and spinal cord tissues.
Main Results:
- The patient developed progressive ascending chemical meningoencephalitis, coma, and died 36 days post-injection.
- CSF vincristine levels were significantly higher than serum levels.
- Autopsy revealed extensive necrosis of the brain and spinal cord, with neuronal loss and gemistocytic astrocyte proliferation.
Conclusions:
- Accidental intrathecal vincristine administration leads to severe, often fatal, neurotoxicity.
- Elevated CSF vincristine concentrations correlate with extensive neuropathological damage.
- Strict adherence to chemotherapy administration protocols is crucial to prevent such iatrogenic errors.