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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Karp BI, "Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia" 72 : 359-373, 1993

2 Sterns RH, "Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective" 4 : 1522-1530, 1994

3 McCormick WF, "Danneel CM. Central pontine myelinolysis" 119 : 444-478, 1967

4 Messert B, "Central pontine myelinolysis. Considerations on etiology, diagnosis, and treatment" 29 : 147-160, 1979

5 Fraser C, "Central pontine myelinolysis following bone marrow transplantation complicated by severe hepatic venoocclusive disease" 36 : 733-734, 2005

6 Fryer JP, "Central pontine myelinolysis and cyclosporine neurotoxicity following liver transplantation" 61 : 658-661, 1996

7 Lampl C, "Central pontine myelinolysis" 47 : 3-10, 2002

8 Singh N, "Central nervous system lesions in adult liver transplant recipients: clinical review with implications for management" 73 : 110-118, 1994

9 Bronster DJ, "Central nervous system complications in liver transplant recipients- incidence, timing, and long-term follow-up" 14 : 1-7, 2000

10 Ashrafian H, "A review of the causes of central pontine myeli-nolysis: yet another apoptotic illness?" 8 : 103-109, 2001