Case of fosphenytoin induced acute cerebellar dysfunction and pituitary bleed causing central diabetes insipidus in a case of AML M2 during allogenic hematopoietic stem cell transplant

Neuroprotectors such as phenytoin, fosphenytoin, clonazepam or levetiracetam are often used prior conditioning regimen to prevent seizures caused due to busulfan, during bone marrow transplant. Fosphenytoin and levetiracetam are used instead of phenytoin as they are readily soluble and do not need a vehicle such as polyethylene glycol or ethanol which increases risk of tissue and cardio toxicity. We report a case of acutetoxicity in the form of cerebral bleed during intravenous administration of fosphenytoin and its subsequent management in patient undergoing busulfan treatment prior to allogenic transplant.