An unusual cause of breath-holding spell in a leukemic infant: Cytarabine

A previously healthy 14-month-old female infant was diagnosed with leukemia. She was in complete remission following induction chemotherapy of the Interfant-06 protocol. Her complete blood count was within normal limits. After the first four cytarabine infusions, she developed a fever, palmar erythema, and edema [Figure 1]. Chemotherapy was discontinued. Cellulitis was suspected, and thus, broad-spectrum antibiotics were started. Her complaint was alleviated. When cytarabine infusion was restarted, fever, bilateral palmar erythema, edema, breath-holding spells, and cyanosis were observed [Video 1]. Her electroencephalogram revealed no abnormalities. All of these findings have been attributed to secondary cytarabine. Both immediate and delayed hypersensitivity reactions to cytarabine have been reported.^[1,2] For allergic reactions, 1 mg/kg methylprednisolone plus antihistamine was administered before cytarabine infusion. All symptoms disappeared. She completed the chemotherapy protocol.

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Figure 1

Palmar erythema and edema in an infant.

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Based on a literature search, the breath-holding spell in a leukemic child caused by cytarabine has been documented for the 1^st time.