Chemotherapy-induced seizures: A rare case of paclitaxel-induced neurotoxicity at Chris Hani Baragwanath Oncology Centre

Abstract

Paclitaxel is widely used for advanced Kaposi sarcoma (KS) in resource-limited settings because of cost-effectiveness and proven efficacy. Neurotoxicity is recognised, but infusion-related seizures are exceedingly rare, particularly in human immunodeficiency virus (HIV)-positive patients. A 32-year-old HIV-positive male, virologically suppressed (CD4 450 cells/mm³), presented with T1-stage nodular KS. Paclitaxel (120 mg/m²) infusion induced a self-limiting generalised tonic-clonic seizure within 10 min. Despite a 20% dose reduction during the second cycle, a similar seizure recurred. Neuroimaging, cerebrospinal fluid analysis, and laboratory investigations were unremarkable. Electroencephalography was unavailable. Paclitaxel was discontinued; doxorubicin-based chemotherapy was initiated, with no further seizures and partial regression of lesions after two cycles.
Contribution: This case identifies paclitaxel-induced seizures as a rare adverse event in an HIV-positive patient, underscoring the need for vigilant infusion monitoring, prompt diagnostic exclusion of opportunistic causes, and individualised chemotherapy selection.