Ifosfamide-Induced Irreversible Encephalopathy

Abstract

Ifosfamide associated central nervous system toxicity has been reported in 5% to 30%of patients treated
with ifosfamide. Death from irreversible encephalopathy has been reported rarely. A 52-year-old lady with
carcinoma of cervix was treated with concurrent chemo-Radiatherapy, and residual disease was given with
new adjuvant chemotherapy, containing regimens ifosfamide and cisplatin. Two days after the initiation of
ifosfamide, the patient exhibited onset of lethal encephalopathy manifested by subacutely progressive
encephlopathy then to a vegetative state and eventually to death. Brain CT-scan showed no metastatic
tumor and vascular cause, blood routine examination for infection and metabolic factors was also negative;
except Urea and Creatinine was increasing. Ifosfamide is known to be capable of causing acute encephalopathy
that can be severe but is generally reversible. This lady showed a very atypical progressive, lethal course of
ifosfamide toxicity. The possibility of this complication should be considered when kidney function is within
normal limits.

Key Words: ifosfamide, encephalopathy.