Medication rationalization resolved recurrent altered mental status in a patient with relapsed plasma cell malignancy receiving combination chemotherapy and psychiatric polypharmacy.
Case Report (n=1)
Early recognition and medication simplification can reduce recurrence of altered mental status and enhance cognitive function in post-transplant oncology patients with psychiatric polypharmacy.
Abstract Altered mental status (AMS) in oncology populations frequently reflects complex interactions among medical, pharmacologic, and neuropsychiatric factors. Accurate identification of the primary contributors is crucial to minimize morbidity. We report the case of a man in his 60s with a relapsed plasma cell malignancy, status post autologous stem-cell transplant, who experienced recurrent AMS during ongoing combination chemotherapy and psychiatric polypharmacy. Neuroimaging excluded structural or vascular lesions. Laboratory evaluation revealed intermittent mild renal dysfunction without metabolic crisis. His medication regimen included multiple serotonergic, dopaminergic, and sedative agents; clinical improvement followed medication rationalization. This case highlights the multifactorial nature of AMS in cancer survivors, in which post-transplant neuroinflammation, systemic metabolic stress, and overlapping drug effects create a brain vulnerable to toxic-metabolic encephalopathy. A systems-based, interdisciplinary approach is essential for diagnosing and preventing AMS in post-transplant oncology patients. Early recognition and medication simplification can reduce recurrence and enhance cognitive function.
Woytowitz et al. (Sat,) conducted a case report in Relapsed plasma cell malignancy and altered mental status (n=1). Medication rationalization was evaluated on Clinical improvement of altered mental status. Medication rationalization resolved recurrent altered mental status in a patient with relapsed plasma cell malignancy receiving combination chemotherapy and psychiatric polypharmacy.