Posterior reversible encephalopathy syndrome in a postpartum woman with acute lymphoblastic leukaemia after intrathecal methotrexate

Abstract

Posterior reversible encephalopathy syndrome (PRES) is the most common neurological complication occurring in children undergoing induction chemotherapy for acute lymphoblastic leukaemia (ALL) but is increasingly recognised to occur in adults as well. Here, we report a woman who presented with B-cell ALL (B-ALL) at the time of delivery and developed PRES 1 day after receiving intrathecal (IT) methotrexate (MTX) that rapidly resolved. She subsequently received IT MTX without recurrence of neurological symptoms. This case represents the first case of PRES in a postpartum B-ALL patient receiving IT MTX, demonstrates that re-treatment with MTX in this case could be done safely and highlights the risk of PRES in adults treated for B-ALL.

A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia

“…In pediatric oncology, PRES most often occurs as a complication of chemotherapy, rather than the presentation of a new diagnosis. PRES can be seen as a result of hypertension associated with steroid courses for induction chemotherapy and/or due to synergistic neurotoxicity of multiple chemotherapeutic agents 31 . PRES has been shown to be a complication of all of the following chemotherapy regimens: VEGF inhibitors, cisplatin/platinum‐based agents, cyclosporine A, cytarabine, gemcitabine, INF‐a, ipilimumab, methotrexate, rituximab, tacrolimus, sirolimus, tyrosine kinase inhibitors, and vincristine 32 .…”