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Extensive acute toxic leukoencephalopathy induced by Fludarabine: Two months follow-up on brain MRI

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Introduction

Acute toxic leukoencephalopathy (ATL) is a rare but classical complication of Fludarabin with poor prognosis. Here, we report a case of Fludarabin toxicity with four successive MRI during follow-up that reveal new data about its extension and the evolution of diffusion-weighted imaging (DWI) in specific areas.

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Case report

A 51-year-old man, with a diagnosis of type IV acute myelogenous leukemia, underwent a first chemotherapy (Cytarabine + Daunorubicine) in March. In May and July, he underwent consolidation chemotherapies based on 5-day infusion of Cytarabine and Clofarabine. Remission was obtained and he was conditioned for a blood marrow transplant (BMT) with 5-day of Cyclophosphamide and Fludarabine (40 mg/m2 per day) followed by a single total body irradiation of 2 Gy the day before the BMT. The BMT was done on

Discussion

The lesions were considered as acute toxic leukoencephalopathy secondary to Fludarabine administration. The detailed MRI follow-up, from the very beginning of the symptoms to death, had not been reported in the literature before and provides new data about DWI abnormalities in this rare toxic condition.

Other diagnoses were ruled out. Metabolic causes might have been possible in front of bilateral and symmetric lesions but biological analyses were always normal. Leukemia relapse was poorly

Conclusion

To our knowledge, this case exposes a rare MRI follow-up of Fludarabine ATL, which provides new data about development and extension of the lesions, together with ADC evolution during the course of the disease.

Author contribution

A.C.: study design, drafting and critical revision of the manuscript. N.A.: study design, drafting and critical revision of the manuscript. M.G.: data acquisition and analysis. A.G.: patient care. E.D.: patient care, data acquisition. V.D.: critical revision of the manuscript for intellectual content. T.T.: critical revision of the manuscript for intellectual content.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Consent: written informed consent was obtained from the patient's next of kin.

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