Fulminant peripheral neuropathy with severe quadriparesis associated with vincristine therapy

• Published in: The Annals of pharmacotherapy 2000-10, Vol.34 (10), p.1136-1138
• Main Authors: Moudgil, SS, Riggs, JE
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents, Phytogenic - adverse effects; Antineoplastic Agents, Phytogenic - therapeutic use; Biological and medical sciences; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Drug toxicity and drugs side effects treatment; Fatal Outcome; Guillain-Barre Syndrome - complications; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Peripheral Nervous System Diseases - chemically induced; Peripheral Nervous System Diseases - pathology; Pharmacology. Drug treatments; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Quadriplegia - chemically induced; Toxicity: nervous system and muscle; Vincristine - adverse effects; Vincristine - therapeutic use
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.19396

OBJECTIVE: To report a case of fulminant neuropathy with severe quadriparesis associated with vincristine chemotherapy. CASE SUMMARY: A 48-year-old white man with acute lymphoblastic leukemia was started on an induction chemotherapeutic regimen that included intravenous vincristine. He received a total of 6 mg of vincristine over two weeks during induction chemotherapy. Over the next two weeks, he developed a fulminant peripheral neuropathy with severe quadriparesis. DISCUSSION: Although commonly associated with peripheral neuropathy, vincristine neurotoxicity only rarely involves instances of fulminant peripheral neuropathy with severe quadriparesis. Guillain-Barré syndrome is also associated with leukemia and may present as a fulminant peripheral neuropathy with severe quadriparesis. CONCLUSIONS: Fulminant neuropathy with severe quadriparesis occurring in patients with leukemia being treated with vincristine (and who do not have coexistent Charcot-Marie-Tooth disease) is more likely due to Guillain-Barré syndrome than to vincristine neurotoxicity.