Delirium in acute promyelocytic leukemia patients: two case reports

Abstract

BackgroundDelirium is a frequently misdiagnosed and inadequately treated neuropsychiatric complication most commonly observed in terminally ill cancer patients. To our knowledge this is the first report describing delirium in two patients aged less than 60 years and enrolled in an intensive chemotherapeutic protocol for acute promyelocytic leukemia.Case presentationTwo female Caucasian acute promyelocytic leukemia patients aged 46 and 56 years developed delirium during their induction treatment with all-trans retinoic acid and idarubicin. In both cases symptoms were initially attributed to all-trans retinoic acid that was therefore immediately suspended. In these two patients several situations may have contribute to the delirium: in patient 1 a previous psychiatric disorder, concomitant treatments with steroids and benzodiazepines, a severe infection and central nervous system bleeding while in patient 2 steroid treatment and isolation. In patient 1 delirium was treated with short-term low-doses of haloperidol while in patient 2 non-pharmacologic interventions had a beneficial role. When the diagnosis of delirium was clear, induction treatment was resumed and both patients completed their therapeutic program without any relapse of the psychiatric symptoms. Both patients are alive and in complete remission as far as their leukemia is concerned.ConclusionsWe suggest that patients with acute promyelocytic leukemia eligible to intensive chemotherapy should be carefully evaluated by a multisciplinary team including psychiatrists in order to early recognize symptoms of delirium and avoid inadequate treatments. In case of delirium, both pharmacologic and non-pharmacologic interventions may be considered.

Clinical risk factors associated with postoperative delirium and evaluation of delirium management and assessment team in lung and esophageal cancer patients

“…Delirium is a disturbance of consciousness characterized by changes in cognition, perceptual disturbances, and a reduced ability to focus, sustain, or shift attention [ 1 ]. These symptoms typically manifest in disorientation, memory impairment, and alteration of mental processes, which can present as a hyperactive form, a hypoactive form, or a combination of the two [ 2 , 3 ].…”

Delirium as a Presenting Feature of Myelodysplastic Syndrome in Old Age: A Case Report

“… 4 An earlier case report has also described the development of delirium in patients with promyelocytic leukemia while under induction therapy. 5 Falls, insomnia, and weakness are common presenting features of MDS due to the development of pancytopenia, but no literature exists on different presentations of delirium in hematological malignancies. In this context, our case report appears to be the first one describing delirium as a presenting feature of MDS.…”