Bortezomib-induced Posterior Reversible Encephalopathy Syndrome in a Patient with Newly Diagnosed Multiple Myeloma

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a known but extremely rare side effect of bortezomib therapy. An unusual case of PRES possibly caused by bortezomib during induction treatment in a patient with multiple myeloma is reported. The patient experienced neither hypertensive crisis nor uremic encephalopathy at the onset of PRES, which are both well-known etiologies of PRES. The patient's PRESrelated symptoms resolved completely after discontinuation of bortezomib and administration of a bulk dose of corticosteroids. The importance of early recognition of this potential neurological complication must be emphasized because this new drug is being increasingly prescribed.

Bortezomib-induced Posterior Reversible Encephalopathy Syndrome: Clinical and Imaging Features

“…PRES is a rare and potentially harmful complication of multiple myeloma (3,5,6). We herein describe a case involving a presentation typical of PRES, in both clinical and radiological aspects, attributed to bortezomib as the most possible offending agent.…”

“…Although PRES has been increasingly identified within the setting of oncology among patients receiving chemotherapy and targeted agents (1, 2), only four cases associated with bortezomib treatment have been reported to date (3,(5)(6)(7). The clinical characteristics, including those of the present case, are outlined in Table. Among these cases, there was a female predominance (80%) and preferential attacks among subjects more than fifty years of age.…”

“…Among the imaging findings, extensive and/or asymmetric white matter lesions were observed to be disproportionately involved in the occipital lobes. Signal changes in the neighboring gray matter and thalamus were also noted in some full-blown cases (3,5). A rapid clinical recovery, associated with the reversal of neurological imaging findings in a centripetal manner, was achieved under prompt management in several cases.…”

“…Overwhelmed cerebral autoregulation is presumed to be the major process leading to such dramatic alterations in both clinical and radiological aspects (3). This neurological emergency is linked with the use of hemodialysis and chemotherapy as well as autoimmune disorders, preeclampsia/eclampsia and various forms of glomerulopathy (4).…”

Bortezomib-induced posterior reversible encephalopathy syndrome: a case report

“…It acts through the inhibition of nuclear factor kappa B (NF-kB) activity. Few neurological complications have been reported in association with the use of bortezomib, predominantly peripheral neuropathies, and to date, only six cases [2][3][4][5][6][7] of PRES.…”