Posterior reversible encephalopathy syndrome in an adult patient with acute lymphoblastic leukemia after remission induction chemotherapy

Abstract

Posterior reversible encephalopathy syndrome (PRES) has been reported in childhood leukemia patients increasingly frequently. However, the development of PRES in adult leukemia patients during chemotherapy is very rare. We present a case of PRES in an adult patient with acute lymphoblastic leukemia (ALL) after remission induction chemotherapy. A 28-year-old woman with ALL was administered remission induction chemotherapy consisting of cyclophosphamide, daunorubicin, vincristine, prednisone, and L-asparaginase. After initiation of chemotherapy, the patient developed paralytic ileus and hypertension, and on day 30, she suddenly developed generalized convulsions, loss of visual acuity, and muscle weakness in the legs. Magnetic resonance imaging findings and her signs and symptoms were typical of PRES. The symptoms gradually improved following treatment with an anticonvulsant and an antihypertensive agent, and the patient underwent allogeneic bone marrow transplantation. She has completely recovered from PRES and has been asymptomatic without leukemia relapse. During remission induction chemotherapy for ALL, PRES may be caused by multiple drugs, such as L-asparaginase, vincristine, and corticosteroids, with different mechanisms of action. PRES should be recognized as an important complication, which will occur more frequently with the increased intensity of chemotherapy for adult ALL patients.

Posterior Reversible Encephalopathy Syndrome due to High Dose Corticosteroids for an MS Relapse

“…There are several case reports of PRES being related to CR use. In most cases, however, the patient was also on another medication, such as CHOP or cisplatin chemotherapy for an underlying hematologic cancer [ 10 , 11 ], or was acutely ill and normotensive [ 12 ] and thus a causal relationship between CR and PRES cannot be definitively made. There are two pediatric cases of PRES associated with pulses of high CR similar to our case, but in these cases, the patients were also acutely ill [ 13 , 14 ].…”

Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals

“…Both direct effects of chronic or reactivated HHV-6 infection and autoimmune mechanisms are suspected (Raspall-Chaure et al 2013 ). In one case, posterior reversible encephalopathy syndrome (PRES) has been associated with HHV-6B infection (Kawamura et al 2013 , 2012 ), and in another case, PRES was elicited by combined chemotherapy consisting of drugs known to activate HHV-6, although its presence was not tested (Tsukamoto et al 2012 ). Host defense systems that are suppressed due to reasons other than transplantation might also predispose to HHV-6 reactivation and encephalitis.…”

Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy

“…Although the mechanism underlying PRES during L-ASP is still unclear, microthrombosis or direct endothelial damage have been hypothesized to play a role. [ 1 ] In-vitro experiments suggest that chemotherapy drugs, including L-ASP, can induce expression of tissue factor (TF) and a procoagulant activity on endothelial cells, where the injury to endothelium could contribute to hypercoagulability. [ 4 ] L-ASP carries neurotoxicity which seems to be even more pronounced with E. coli L-ASP, as in the case reported herein.…”

“…Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome characterized by typical neurological and magnetic resonance imaging (MRI) findings. [ 1 2 ] The neurological picture includes a headache, altered mental status, seizures, abnormal visual perception and occasionally, focal neurological signs. Typical MRI findings include bilateral subcortical and cortical edema with a predominant posterior distribution.…”