J Korean Med Sci.  2008 Apr;23(2):324-327. 10.3346/jkms.2008.23.2.324.

Central Pontine Myelinolysis in a Patient with Acute Lymphoblastic Leukemia after Hematopoietic Stem Cell Transplantation: A Case Report

• Lim KH
• Kim S
• Lee YS
• Kim KH
• Kim J
• Rhee JY
• Kim HJ
• Yi HG
• Oh SY
• Lim JH
• Han SW
• Lee S
• Kim I
• Yoon SS
• Park S
• Kim BK

• KMID: 1713469
• DOI: http://doi.org/10.3346/jkms.2008.23.2.324

Abstract

We describe a 37-yr-old man who developed central pontine myelinolysis (CPM) after allogeneic hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia. After HSCT, desquamation developed on the whole body accompanied by hyperbilirubinemia. The liver biopsy of the patient indicated graft-versus-host disease- related liver disease, and the dose of methylprednisolone was increased. Then, the patient developed altered mentality with eye ball deviation to the left, for which electroencephalogram and magnetic resonance imaging (MRI) scans were done. Brain MRI scan demonstrated the imaging findings consistent with central pontine myelinolysis and extrapontine myelinolysis. He did not have any hyponatremia episode during hospitalization prior to the MRI scan. To the best of our knowledge, presentation of CPM after allogeneic HSCT is extremely rare in cases where patients have not exhibited any episodes of significant hyponatremia. We report a rare case in which hepatic dysfunction due to graft-versus-host disease has a strong association with CPM after HSCT.

Keyword

Myelinolysis, Central Pontine; Hematopoietic Stem Cell Transplantation; Graft versus Host Disease

MeSH Terms

Adult
Biopsy
Brain/pathology
Electroencephalography
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Hyperbilirubinemia/etiology
Liver/pathology
Magnetic Resonance Imaging
Male
Myelinolysis, Central Pontine/complications/*etiology
Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*therapy
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Needle biopsy of the liver. The GVHD here is affecting the liver and marked by bile duct damage (hematoxylin and eosin stain, ×400).

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  Fig. 2 Brain MRI reveals nonspecific findings including multiple white matter low densities.

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  Fig. 3 Serial changes of BUN and Cr.

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  Fig. 4 Low amplitude theta slowings at all leads on electroencephalogram indicate diffuse cerebral dysfunction.

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  Fig. 5 Follow-up Brain MRI showed diffuse marked progression of confluent white matter T2 high-signal lesion in both periventricular white matter, basal ganglia, pons, and cerebellum, consistent with CPM.

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  Fig. 6 Serial changes of sodium (Na) and osmolarity (Osm).

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