Three children with refractory leukemia treated by bone marrow transplantation at the Children’s National Medical Center, Washington, DC, developed encephalopathy, leukoencephalopathy, and parkinsonism after receiving high-dose amphotericin B for pulmonary aspergillosis. All 3 had previously been treated with high-dose chemotherapy and total body irradiation. MRIs showed basal ganglia, cerebellar, and cerebral atrophy, and frontal and temporal lobe white matter changes. One died and two recovered after withdrawal of the amphotericin, 1 having intellectual impairment. [1]
COMMENT. Neurologic complications of bone marrow transplantation in children with leukemia are a common occurrence. These have included seizures, infections, and encephalopathies, but Parkinsonian symptoms associated with amphotericin B appear to be unique.