Posterior reversible encephalopathy syndrome following chemotherapy with oxaliplatin and a fluoropyrimidine: A case report and literature review

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological syndrome characterized by seizures, altered level of consciousness and visual disturbance. PRES is associated with hyperintense lesions on magnetic resonance imaging (MRI) most commonly seen in the posterior regions. In most cases symptoms and radiological lesions are reversible. The aims of this article are: (i) to review the literature for all cases involving oxaliplatin, fluoropyrimidine and bevacizumab and (ii) highlight the increasing number of cases attributed to anti-neoplastic agents. An in-depth literature review was conducted by utilizing Pubmed's MEDLINE and Google Scholar databases. We found that there have been nine cases of PRES associated with oxaliplatin or fluoropyrimidine therapy; five cases also involved therapy with bevacizumab. Eight of the nine patients made a full recovery with a complete resolution of MRI changes. This is the first Australian case of PRES following treatment with oxaliplatin and a fluoropyrimidine and only the second case reported in which the patient did not recover despite appropriate medical management. It appears that PRES maybe more commonly associated with multi-agent therapies and although reversible in most cases, PRES may result in adverse outcomes despite rapid intervention.

Posterior reversible encephalopathy syndrome resulting from repeat bortezomib usage

“…The current case supports the observation that bortezomib-induced PRES is more common in women, with four of the five current cases occurring in female patients. This is also consistent with cases reported for other molecular targeting agents 13 17. Our patient had a full neurological recovery with discontinuation of bortezomib.…”

“…This is the first report of a patient becoming comatose and requiring prolonged intubation and invasive mechanical ventilation in the ICU. Risk factors for development of PRES include hypertension, renal dysfunction, immunosuppression and treatment with chemotherapeutic agents 13. The patient presented here had all of these risk factors with the exception of renal dysfunction.…”

Pazopanib-associated posterior reversible encephalopathy syndrome with intracerebral haemorrhage

“…Haemorrhage is believed to occur either due to arterial rupture secondary to significantly elevated blood pressure or postischemic reperfusion injury 2. While commonly associated with hypertension and eclampsia, a number of chemotherapeutic and immunosuppressive agents have also been linked to PRES 3. Renal impairment has also been associated with the syndrome 4.…”

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

“…Examining the four cases of bortezomib-induced PRES, including the present case, the following were found to be common features. First, the condition appears to be prevalent in women, as previously suggested for other molecular targeting agents, such as anti-vascular endothelial growth factor (VEGF) (11,12). Second, PRES occurred at a relatively early phase; in fact, two patients developed PRES within the first cycle of administration of bortezomib, which is in contrast to that observed in cases related to anti-VEGF or RAF kinase inhibitor.…”