Posterior Reversible Encephalopathy Syndrome Secondary to Cyclophosphamide in the Treatment of Pulmonary Renal Syndrome

Pan, Di; Sabharwal, Basera; Vallejo, Franco

doi:10.1016/j.chest.2017.08.393

Cited by 5 publications

(6 citation statements)

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“…All of these case reports are young individuals with an underlying rheumatological condition causing renal failure who developed PRES while receiving cyclophosphamide for their underlying rheumatologic condition. Majority of these cases had SLE with nephritis, however along with Abenza-Abildua et al, our case reports PRES caused by cyclophosphamide use to treat Anti-GBM vasculitis [26]. Our case report provides further insight into the pathophysiology of immunosuppressants causing PRES; specifically in patients with renal failures and Anti-GBM vasculitis undergoing treatment with cyclophosmaphide.…”

Section: Discussionmentioning

confidence: 52%

“…Abenza-Abildua reported another case of PRES in a 27-year-old man with high blood pressure (HBP) and glomerulonephritis caused by anti-GBM disease treated with cyclophosphamide [29]. Di Pan reported PRES in a 22-year-old woman with a history of Sjogren's syndrome who had an acute respiratory failure from diffuse alveolar hemorrhage concurrent with renal failure from glomerulonephritis, who was treated with cyclophosphamide on day 2, and developed seizures on day 5, with findings concerning for PRES on neuroimaging [26]. All of these case reports are young individuals with an underlying rheumatological condition causing renal failure who developed PRES while receiving cyclophosphamide for their underlying rheumatologic condition.…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Cyclophosphamide-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-GBM Vasculitis, and Review of Current Literature

Nisar

Alchaki

Feinstein

2019

Case Reports in Neurological Medicine

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Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome of headache, altered mental status, and seizures with reversible mainly posterior leukoencephalopathy on neuroimaging. Precipitating factors for PRES are multifactorial and include autoregulatory failure due to changes in blood pressure, metabolic derangements, and cytotoxic medications. We report the second case of cyclophosphamide-induced PRES in a patient with anti-glomerular basement membrane (Anti-GBM) positive vasculitis. In the acute setting, PRES can be challenging to distinguish from cerebral venous sinus thrombosis or cerebral vasculitis based on clinical presentation. Neuroimaging with magnetic resonance imaging (MRI) of the brain along with a vessel imaging, can help reach the diagnosis.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

A Rare Case of Cyclophosphamide-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-GBM Vasculitis, and Review of Current Literature

Nisar

Alchaki

Feinstein

2019

Case Reports in Neurological Medicine

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“…It took longer to develop PRES with oral cyclophosphamide compared to IV drugs. Furthermore, two patients with ANCA-associated vasculitis and one with lupus nephritis who used IV injection developed PRES in 3 d[ 5 , 6 , 11 ]. Among two cases of oral cyclophosphamide-induced PRES, Cha et al [ 7 ] reported a 36-year-old woman with anti-GBM Ab glomerulonephritis treated with oral methylprednisolone, plasmapheresis and oral cyclophosphamide who suddenly developed PRES after 3 mo of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Cyclophosphamide is an alkylating agent widely used in the treatment of certain malignancies and autoimmune diseases[ 3 , 4 ]. Intravenous (IV) cyclophosphamide-induced PRES has been reported in several cases where cyclophosphamide was used to treat rapidly progressive glomerulonephritis (RPGN) including anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis[ 3 , 5 , 6 ]. However, all these cases occurred at least 3 wk after administration of oral cyclophosphamide[ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Oral cyclophosphamide-induced posterior reversible encephalopathy syndrome in a patient with ANCA-associated vasculitis: A case report

Kim¹,

Kwak²,

Jung³

et al. 2021

WJCC

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BACKGROUND Posterior reversible encephalopathy syndrome (PRES) manifests many neurological symptoms with typical features on neuroimaging studies and has various risk factors. Cyclophosphamide is one of the therapeutic agents for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Cyclophosphamide as the sole cause of PRES has been reported in only a few cases. Herein, we report a unique case of early-onset oral cyclophosphamide-induced PRES in a patient with ANCA-associated vasculitis. CASE SUMMARY A 73-year-old man was transferred to our hospital for sepsis due to acute cholangitis. He had already received hemodialysis for two weeks due to septic acute kidney injury. His azotemia was not improved after sepsis resolved and perinuclear-ANCA was positive. Kidney biopsy showed crescentic glomerulonephritis. Alveolar hemorrhage was observed on bronchoscopy. He was initially treated with intravenous methylprednisolone and plasma exchange for one week. And then, two days after adding oral cyclophosphamide, the patient developed generalized tonic-clonic seizures. We diagnosed PRES by Brain magnetic resonance imaging (MRI) and electroencephalography. Seizures were controlled with fosphenytoin 750 mg. Cyclophosphamide was suspected to be the cause of PRES and withdrawal. His mentality was recovered after seven days and brain MRI showed normal state after two weeks. CONCLUSION The present case shows the possibility of PRES induction due to short-term use of oral cyclophosphamide therapy. Physicians should carefully monitor neurologic symptoms after oral cyclophosphamide administration in elderly patients with underlying diseases like sepsis, renal failure and ANCA-associated vasculitis.

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“…Cyclophosphamide (CYP) is an immunosuppressive drug that is commonly used for the treatment of different autoimmune diseases and malignancies. It acts by inhibiting cellular and humoral immunity [3]. The most commonly reported side effects include bone marrow suppression, liver injury, cardiotoxicity, stomatitis, and hemorrhagic cystitis.…”

mentioning

confidence: 99%

A case of cyclophosphamide-induced posterior reversible encephalopathy syndrome: Is it dose-related side effect?

Sulaiman¹,

Yasin²,

Ismail³

2022

YJM

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We reported a case of cyclophosphamide (CYP)-induced posterior reversible encephalopathy syndrome (PRES) in a 26-year-old previously healthy male patient who presented to the emergency department with a history of fever, shortness of breath, and hemoptysis. After extensive investigations, including bronchoscopy and autoimmune screening, he was diagnosed with the renal-pulmonary syndrome. The diagnosis of CYP-related PRES was based on the development of a neurological clinical picture supported by magnetic resonance imaging findings. The dose of CYP was decreased to 75 mg/day, and the patient’s symptoms improved after 3 days.

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Posterior Reversible Encephalopathy Syndrome Secondary to Cyclophosphamide in the Treatment of Pulmonary Renal Syndrome

Cited by 5 publications

References 0 publications

A Rare Case of Cyclophosphamide-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-GBM Vasculitis, and Review of Current Literature

A Rare Case of Cyclophosphamide-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-GBM Vasculitis, and Review of Current Literature

Oral cyclophosphamide-induced posterior reversible encephalopathy syndrome in a patient with ANCA-associated vasculitis: A case report

A case of cyclophosphamide-induced posterior reversible encephalopathy syndrome: Is it dose-related side effect?

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