Although carmustine (Gliadel) wafers improve local tumor control and extend the overall survival in patients with malignant glioma, adverse effects have been documented. The authors report the first case of eosinophilic meningitis triggered by the placement of Gliadel wafers. A 61-year-old man with a history of alimentary allergy and glioblastoma in the right frontal lobe underwent resection followed by the implantation of Gliadel wafers. Three weeks later he suffered the sudden onset of headache, vomiting, and progressive consciousness disturbance. Computed tomography revealed enlargement of the ventricular system and subdural space on the side of the tumor. His CSF leukocyte count increased up to 3990 cells/mm3; 95% of the cells were eosinophilic granulocytes (EGs), suggesting eosinophilic meningitis. Laboratory examination showed the patient to have various elevated allergy indicators. The administration of corticosteroids failed to improve his condition. Despite the insertion of a lumbar drain his symptoms failed to improve. He underwent a second surgical intervention to remove the Gliadel wafers. Histologically, EGs had assembled around the wafers. Eosinophilic infiltrate was present in the brain parenchyma around small vessels. After ventriculoperitoneal shunting his course was favorable. A drug lymphocyte stimulation test against the Gliadel wafers failed to demonstrate a positive reaction; polifeprosan, the wafer matrix without 1,3-bis(2-chloroethyl)-1-nitrosourea, yielded a positive reaction. These findings strongly suggest that although extremely rare, polifeprosan (the wafer matrix) can elicit an allergic reaction. When eosinophilic meningitis is suspected after the implantation of Gliadel wafers, their immediate removal should be considered.
Kiyotaka Saito, Kouji Yamasaki, Kiyotaka Yokogami, Asya Ivanova, Go Takeishi, Yuichiro Sato and Hideo Takeshima
Shinji Yamashita, Kiyotaka Yokogami, Fumitaka Matsumoto, Kiyotaka Saito, Asako Mizuguchi, Hajime Ohta and Hideo Takeshima
The authors assessed MGMT promoter methylation results obtained by methylation-sensitive PCR (MS-PCR) and high-resolution melting (MS-HRM) methods to determine whether MS-HRM overcomes the limitations of MS-PCR. They found that MS-HRM was superior to MS-PCR for predicting survival outcome in 75 GBM patients with and without MGMT promoter methylation. Based on the results of multivariate Cox analysis, MS-HRM revealed independent prognostic factors. The authors suggest that MS-HRM is optimal for assessing the MGMT promoter methylation status and that it represents an alternative to MS-PCR.