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Encephalopathy,leukoencephalopathy,and secondary parkinsonism occurred in 3 children with refractory leukemia undergoing allogenic bone marrow transplantation(BMT)who were treated with high-dose amphotericin B for pulmonary aspergillosis or sinus aspergillosis that did not involve the nervous system.Treatment included high-dose cytosine arabinoside, cyclophosphamide,and total body irradiation prior to the BMT.The children developed a progressively worsening encephalopathy and parkinsonian features,characterized by resting tremor,cogwheel rigidity,and masklike facies.Neuroimaging studies showed cerebellar,cerebral,and basal ganglia atrophy,as well as frontal and temporal lobe white matter involvement.Two of the 3 patients recovered,although 1 has residual intellectual impairment.The third succumbed to non-central nervous system Epstein-Barr virus-lymphoproliferative disease and had autopsy-confirmed leukoencephalopathy. |
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