Fatal ischemic stroke in a patient receiving lenalidomide for multiple myeloma

Abstract

Lenalidomide is a novel treatment that significantly increases urvival time in patients with relapsed or refractory multiple yeloma [1]. Known side effects include neutropenia, thromboytopenia and venous thromboembolism [1]. Recently, a 54-year-old female was admitted to our hospital ith a previous history of multiple myeloma. She was treated with enalidomide (25mg PO) in combination with the usual regimen f dexamethasone 40mg PO once a week. Other actual medication ncluded paracetamol, pregabaline and fentanyl patches for neuopathic pain. One week later, she was found on the floor by her on in an unconscious state. It could be reconstructed that she had een unconscious for approximately one day when she was found. ater, her brother reported that twodaysprior to admission shehad xperienced a sudden weakness on the right side of the body, for hich she had not soughtmedical attention. Besides suffering from ultiplemyeloma, hermedical historywas unremarkable. She had o previous history of smoking, vascular disease, diabetes, or any ther known risk factors for stroke. Six months previously, under uspicion of cardiac amyloidosis, she had undergone an extensive nalysis by a cardiologist which had revealed no abnormalities. Upon admission to the hospital, she was comatose (E1M4V1), ith a pathological extension of the right arm and flexion of the eft arm on a painful stimulus. Hyperreflexia and a Babinski’s sign n the right side were present. A cerebral CT-scan revealed large ypodense areas in the vascular territories of both middle cereral arteries (Fig. 1). Apart from an elevated serum creatine kinase 1499 IU/l), presumably from prolonged immobilization on the oor, laboratory investigations revealed no abnormalities. The limted options for treatmentwere discussedwith the patient’s family, ho agreed to wait and see. The patient was admitted to the eurology ward where she died the following day. No additional