A 70-year-old man with history of diabetes mellitus presented with progressive shortness of breath in June 2004. He was diagnosed to have stage IV mucosa-associated lymphoid tissue type of non-Hodgkin's lymphoma (MALTOMA)involving his left upper lung and left-sided pleural effusion with bone marrow involvement. Computed tomography (CT) of the brain was negative for space-occupying lesion at baseline. He completed five cycles of the "CVP" regime (cyclophosphamide, vincristine and prednisolone) and partial response was achieved with reduction in the amount of pleural effusion radiologically. He presented 2 months after the last course of chemotherapy to the emergency ward with increased shortness of breath and his disease progressed with redevelopment of symptomatic left-sided pleural effusion. He was started on oral chlorambucil as a single agent at a dose of 16 mg/m~2 daily for 5 days (total 24 mg daily). On day 6 of therapy he developed tonic-clonic seizure, which was controlled with i.v. diazepam andphenytoin. CT brain with contrast carried out the following day showed no malignant involvement. Blood test including complete blood count, electrolytes, thyroid function, glucose, B12, folate level, arterial blood gas were all normal. Electrocardiogram was unremarkable. He was afebrile and physical examination did not show signs of memngism. Neurological examination was normal. On further questioning it was found that he had neither a history of alcoholism nor a history of epileptic seizures. He had no further seizure after cessation of chlorambucil.
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