A Case of Fatal Delayed Neurological and Systemic Complications in Molecularly Defined Anaplastic Oligodendroglioma
Abstract
Background: Anaplastic oligodendroglioma (WHO grade III) is a relatively uncommon glioma defined by IDH mutation and 1p/19q codeletion and is often associated with comparatively favorable outcomes following maximal surgical resection and adjuvant chemoradiotherapy. Reports describing fatal delayed neurological and systemic complications in molecularly defined anaplastic oligodendroglioma remain limited, particularly from resource-limited settings. Case Summary: We report the case of a 38-year-old man from Shangla, Pakistan, with a molecularly confirmed WHO grade III (IDH-mutant, 1p/19q-codeleted) oligodendroglioma who underwent gross total resection followed by temozolomide-based chemoradiotherapy, achieving an initial period of clinical stability. Earlier surveillance MRI studies performed in July 2023 and a subsequent follow-up MRI in April 2024 demonstrated stable postoperative changes without evidence of residual or recurrent disease. Over time, however, he developed severe delayed complications, including post-treatment encephalomalacia, aspiration pneumonia, and lymphocytic meningitis, culminating in death. During this period, the patient developed dysphagia, impaired consciousness, and loss of independent ambulation, suggesting bulbar dysfunction and reduced airway protective reflexes. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis with markedly elevated protein levels (881 mg/dL) and normal glucose, with negative Gram and Ziehl–Neelsen staining, supporting a diagnosis of lymphocytic meningitis in the setting of a structurally compromised central nervous system. Conclusion: This case demonstrates that fatal delayed neurological and systemic complications may occur in patients with molecularly favorable anaplastic oligodendroglioma despite appropriate standard-of-care treatment and absence of radiological tumor recurrence. Vigilant long-term neurological surveillance, early recognition of bulbar dysfunction, and proactive prevention of aspiration and infection are essential components of survivorship care, particularly in resource-limited settings. Key Words: Anaplastic Oligodendroglioma, Neurological Complications, Systemic Complications.