Acute Encephalopathy in 3 Adolescent Patients With Acute Lymphoblastic Leukemia During Induction Chemotherapy: A Case Series.

Three adolescent patients with B-cell acute lymphoblastic leukemia (B-ALL) presented with psychotic symptoms, mutism, movement disorders, and day-night disturbances during induction chemotherapy, which clinically resembled anti-NMDAR encephalitis. However, all patients were negative for anti-NMDAR antibodies. They also experienced chemotherapy-induced liver dysfunction, weight loss, and malnutrition, which led to biochemical changes (elevated blood ammonia, elevated blood glutamate, and copper deficiency) known to affect NMDA receptor activity. This suggests that there may be some common, undefined pathways in these 2 different pathologies. Early nutritional intervention should be considered for patients who may be at risk for this significant neurotoxicity.