Reactions 1152 - 19 May 2007

STheophylline

Encephalopathy in a child treated with hypothermictherapy: case report

A 4-year-old girl developed acute encephalopathy duringtreatment with theophylline for asthma and was successfullytreated with hypothermic therapy.

The girl received theophylline [dosage and duration oftreatment not stated] and was admitted with status epilepticusand fever.

The girl received IV diazepam, phenytoin and pentobarbital,but her convulsions persisted for over 90 minutes. Onadmission, she was diagnosed with acute encephalopathywhich was thought might be associated with theophylline.Laboratory tests revealed hyperglycaemia (306 mg/dL),elevated serum ferritin levels (1280 ng/mL),hyperammonaemia (162 mg/dL), a serum theophyllineconcentration of 7.0 mg/dL and a decreased pyridoxal level of3.3 ng/mL. On the third day, she had a creatine kinase level of2675 U/L. CSF analysis revealed an interleukin-6 level of92.7 pg/mL. EEG revealed high-voltage slow waves. Shereceived mild hypothermic therapy, high-dosemethylprednisolone and pyridoxal phosphate. On day 18, herconsciousness recovered and single photon-emission CT(SPECT) revealed asymmetrical decreased perfusion at thefrontal lobes and MRI showed mild atrophic changes in thecerebrum. By day 28, she could walk, but she did not speakand had an IQ test score of 16. Ten months after reactiononset, she had an IQ test score of 87 and SPECT showedimprovement of cerebral perfusion.

Author comment: "We suggest that mild hypothermictherapy in combination with methylprednisolonepulsetherapy and pyridoxal phosphate may be a candidate forthe treatment of theophylline-related encephalopathy."Imataka G, et al. Theophylline-related encephalopathy in childhood: successfultreatment with hypothermic therapy. Acta Neurologica ScandinavicaSupplementum 115 (Suppl. 186): 79 abstr. e-6, 2007 [abstract] - Japan 801073969

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Reactions 19 May 2007 No. 11520114-9954/10/1152-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved