Ifosfamide induced encephalopathy: A rare case presentation and management with review of the literature

Abstract

Ifosfamide-induced encephalopathy (IIE) is a rare adverse event and is usually transient and reversible. However, it may cause permanent neurological dysfunction and even death if not addressed early. The use of aprepitant and presence of acute kidney injury may precipitate IIE. In this report, a 55-year-old female presented with a 3-month history of abdominal mass and bleeding per vagina and was diagnosed as locally advanced high-grade uterine leiomyosarcoma. She underwent surgery followed by adjuvant radiotherapy and combination chemotherapy with doxorubicin plus ifosfamide regimen. During her third cycle chemotherapy, despite dose adjustment of ifosfamide according to patient's creatinine clearance, the patient became aphasic, disoriented, and landed in a stuporous state. After complete evaluation and ruling out other causes, she was diagnosed with IIE for which she was treated with methylene blue and thiamine. This patient showed dramatic response within 8 h of methylene blue administration and complete recovery within 24 h. Our report focuses on the risk factors for the development of IIE and the persistent risk despite ifosfamide dose adjustment according to creatinine clearance.