A CASE REPORT OF IFOSFAMIDE INDUCED ENCEPHALOPATHY IN THE MANAGEMENT OF METASTATIC VULVAR LEIOMYOSARCOMA IN NATIONAL HOSPITAL ABUJA

Introduction: Ifosfamide induced encephalopathy (IIE) is not a common phenomenon and is under reported in our context. Its incidence ranges between 10 to 40% in developed settings. It comprises of a range of neuropsychiatric conditions such as confusion, disorientation, somnolence, agitation, hallucinations, lethargy, and seizures. With the extensive use of ifosfamide in oncology in the management of sarcomas, lymphomas and gynaecologic malignancies, its toxicity may present a challenge to the management of patients with cancer.

Case Presentation: Here we report a case of metastatic recurrent vulvar leiomyosarcoma in a 48-year-old woman, with no family history of cancer. She was referred after the histopathological assessment of a recurrent lesion in her vulvar associated with abdominal distension, a solitary subcutaneous scalp lesion and multiple subcutaneous metastatic nodular lesions at her back. She was investigated and found to be fit for chemotherapy. She was placed on oral dexamethasone, a proton pump inhibitor and antacids and planned to commence systemic chemotherapy using the Ifosfamide based MAID regimen. On the Day 2 chemotherapy infusion, she developed confusion, loss of consciousness and mutism which she recovered completely from 6 hours after suspension of the chemotherapy and institution of emergency medications.

Conclusion: Clinical practitioners are often unable to identify high-risk patients prior to treatment and the unanticipated development of neurologic symptoms may cause treatment delay, treatment discontinuation, and subsequent disruption of treatment plans. Therefore, a high index of suspicion is important to prevent, identify and manage this condition.