Clinical Practice and Cases in Emergency Medicine

Introduction: Ifosfamide is an alkylating chemotherapeutic agent commonly used in the treatment of sarcomas and other malignancies. Neurotoxicity is a recognized adverse effect, most often presenting as encephalopathy. Acute movement disorders such as dystonia are rare and may be underrecognized in the emergency department.

Case Report: We report a 22-year-old woman receiving combination chemotherapy with doxorubicin, ifosfamide, and mesna for breast angiosarcoma who developed acute right-sided neck spasms and involuntary movements within five minutes of initiating ifosfamide infusion. Vital signs were as follows: temperature, 98.0 degrees Fahrenheit; heart rate, 97 beats per minute; respiratory rate, 18 breaths per minute; blood pressure, 130/88 millimeters of mercury; and oxygen saturation, 99% on room air. Examination revealed sustained contraction of the right sternocleidomastoid and trapezius muscles with involuntary head deviation. She had no exposure to medications commonly associated with dystonia. She was treated with intravenous thiamine, benzodiazepines, intravenous fluids, and baclofen, with subsequent improvement.

Conclusion: Acute dystonia represents a rare manifestation of ifosfamide-induced neurotoxicity. Emergency clinicians should consider chemotherapy-related neurotoxicity in patients presenting with acute movement disorders, as early recognition and supportive management may prevent progression.