The patient is a 36 year old female who presented breast cancer with leptomeningeal involvement. A systematic lumbar puncture was performed and sent to the laboratory for CSF analysis. CSF examination using wet mount preparation showed a large number of round spherules. After discussion with the ordering physician, we learnt that the patient had received intrathecal liposomal cytarabine injection 19 days earlier. Cytarabine liposomes are spherules with a granular interior and range in size from 10-30 μm. It can be confused with leukocytes and lead to spurious elevation of CSF leukocytes count. Care needs to be taken in interpreting CSF results in patients who have received intrathecal liposomal cytarabine.
Keywords: cerebrospinal fluid; intrathecal injection; liposomal cytarabin.