Drug-induced encephalopathy in cervical cancers with ifosfamide

Ifosfamide, whether in single or combination regimen, have been used in many centers for end-stage cervical cancer cases or recurrent cases. Although it has shown satisfying results, especially in cases of platinum resistance, this drug is related to various side effects, such as encephalopathy. In this study, several cases of acute encephalopathy in cervical cancer patients treated with ifosfamide chemotherapy are described. This study is a retrospective study using all cervical cancer cases receiving ifosfamide chemotherapy in Sanglah Hospital Denpasar from 2015 to 2017. The diagnosis of encephalopathy was established by neurologists. Data obtained from hospital medical records. There were five patients who received the second line ifosfamide-cisplatin chemotherapy regimen at Sanglah Hospital Denpasar from 2015 to 2017. They had received first-line chemotherapy in form of 6 series of paclitaxel carboplatin and some of them received additional therapy in the form of external radiation and brachytherapy. Ifosfamide-cisplatin chemotherapy was given from one to six series, depending on the patient's response. Side effects in the form of encephalopathy appeared in four patients, while one patient managed to recover. Ifosfamide encephalopathy is a side effect that needs to be monitored. It has varied symptoms, but the symptoms are generally mild. Analysis of patient risk factors, patient education, and preparation for the management of encephalopathy should be performed in all cases that will receive ifosfamide. Methylene blue and thiamine can be used as a prophylactic and therapeutic choice for this condition.

Suspected serotonin syndrome in a patient being treated with methylene blue for ifosfamide encephalopathy

Methylene blue has been used not only as a diagnostic agent, but also as an agent in the treatment of ifosfamide-induced encephalopathy (IIE) for several years. Recently, several cases of suspected serotonin syndrome have been reported in patients who received methylene blue in combination with serotonin active agents. Rodent models have revealed that methylene blue is a potent, reversible inhibitor of monoamine oxidase A. It is well known that serotonin active drugs, in combination with monoamine oxidase inhibitors can produce profound serotonin syndrome. To date, cases of serotonin syndrome, which resulted from concurrent methylene blue and serotonin active agents, have been published in the anesthesia literature. We report the first known case of serotonin syndrome in a patient receiving methylene blue for IIE.

Ifosfamide Encephalopathy and Use of Methylene Blue. A Case Report of Different Sequential Neurotoxicity

Neurotoxicity is a clinically relevant adverse event observed with the use of ifosfamide. It is usually mild, occasionally severe and seldom fatal. Ifosfamide-induced encephalopathy requires interruption of chemotherapy, intravenous hydration and administration of methylene blue. Less is known about the efficacy of methylene blue in avoiding a second episode of ifosfamide-induced encephalopathy while maintaining chemotherapy with ifosfamide. We report a case of a different clinical manifestation of ifosfamide-induced encephalopathy after continued ifosfamide use and despite methylene blue in a patient with retroperitoneal sarcoma.