Reactive arsenical encephalopathy

Adams JH, Haller L, Boa FY et al (1986) Human African trypanosomiasis (T.b. gambiense) a study of 16 fatal cases of sleeping sickness with some observations on acute reactive arsenical encephalopathy. Neuropathol Appl Neurobiol 12 81-94... 

Melarsoprol given intravenously in patients with trypanosomiasis can cause a peripheral neuropathy within 2-5 weeks (SEDA-14, 243). It also causes a reactive arsenical encephalopathy in 3-5% of patients with trypanosomiasis (SEDA-13, 834) (6). 

In 56 patients with African trypanosomiasis, one treated with melarsoprol (total dose 26 mg/kg) developed a reactive arsenical encephalopathy (9). 

Melarsoprol is a trivalent arsenical with activity against East African and West African tiypanosomiasis. It is the dmg of choice in the case of Trypanosoma rhodesiense infection with nervons system involvement (stage II disease) and in stage I patients refractory or intolerant to snramin and pentamidine. Melarsoprol administered intravenonsly can canse a reactive encephalopathy, with a clinical pictnre consisting of high fever, headache, tremor, convnlsions, and on occasion coma and death. The incidence of arsenic encephalopathy varies from 3 to 18% in varions series (SEDA-12, 708) (1). 

B. Melarsoprol This drug is an organic arsenical that inhibits enzyme suUhydryl groups. Because it enters the CNS, melarsoprol is the drug of choice in African sleeping sickness. Melarsoprol is given parenterally because it causes gastrointestinal irritation it may also cause a reactive encephalopathy that can be fatal. 

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