A two-year-old African-American girl with stage IV
hepatoblastoma arrived at a clinic to receive her fourth dose of
vincristine as part of standard induction
therapy. The patient had tolerated her first three doses of
vincristine sulfate 0.7 mg (1.5 mg/m(2)) i.v. without any adverse events. Laboratory tests, including a comprehensive metabolic panel, conducted before
chemotherapy administration were unremarkable. Shortly after the administration of
vincristine, the patient experienced tonic extension of all four extremities and upward sustained deviation of the eyes. The patient then became limp and exhibited perioral
cyanosis. Further evaluation revealed a lack of central pulses and a heartbeat.
Cardiopulmonary resuscitation was begun with chest compressions and
positive-pressure ventilation via a bag-mask device. After approximately 45 seconds, her pulses returned, and perioral
cyanosis resolved. She was admitted to the pediatric intensive care unit for further evaluation. Her serum
electrolyte,
glucose, and
ammonia concentrations were within normal limits. No yeast or bacteria were isolated from the patient's blood. No contributing cardiac or neurologic factors were identified. The patient recovered without sequelae and was discharged after 72 hours. Subsequent doses of
vincristine were administered with no adverse events, and the patient successfully completed her treatment regimen.
CONCLUSION: A two-year-old girl with
hepatoblastoma had seizurelike activity and
cardiac arrest shortly after receiving i.v.
vincristine. She received multiple doses of the
drug before and after this event without a similar reaction. No contributing factors for the one-time event were identified.