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Multiple cerebral lesions complicating therapy with interleukin-2

From the National Institute of Neurological Disorders and Stroke (Dr. Illowsky Karp), the National Cancer Institute (Dr. Yang), National Institutes of Health, Bethesda, MD; the Comprehensive Cancer Center (Dr. Khorsand), University of Wisconsin, Madison, WI; the Center for AIDS Research (Drs. Wood and Merigan), Stanford University, Stanford, CA.
Received September 20, 1995. Accepted in final form February 1, 1996.
Address correspondence and reprint requests to Dr. Barbara I. Karp, Building 10, Rm. 5N-226, NINDS, NIH, Bethesda, MD 20892.

We reviewed the records and radiologic studies of eight patients who developed new focal neurologic abnormalities while receiving interleukin-2 (IL2)-based immunotherapy for malignancy or HIV infection. Initial confusion and delirium in the patients evolved into coma, ataxia, hemiparesis, seizures, and cortical syndromes including aphasia, apraxia, and cortical blindness. Imaging studies showed multiple white and gray matter lesions with a predilection for the occipital poles, centrum semiovale, and cerebellum. After cessation of IL2 treatment, seven patients improved to normal or near-normal neurologic function paralleled by resolution of the lesions on scans. One patient improved only minimally. Possible etiologies for the lesions include an IL2-induced cerebral vasculopathy, a direct toxic effect of IL2, or immunologically mediated damage.

NEUROLOGY 1996;47: 417-424

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