L-Asparaginase-induced Posterior Reversible Encephalopathy Syndrome during Acute Lymphoblastic Leukemia Treatment in Children

Abstract

L-asparaginase is a critical component in the treatment of acute lymphoblastic leukemia in children. It is known to cause coagulation abnormalities, thrombosis and hemorrhage in the central nervous system in addition to vasculitis and hypersensitivity reactions. The purpose of this article is to present the first case-series of posterior reversible encephalopathy syndrome (PRES) associated with L-asparaginase treatment. We report 3 cases of children with acute lymphoblastic leukemia who developed seizures and altered sensorium after L-asparaginase therapy. MRI showed increased T(2) signal intensity predominant in the posterior regions of the brain suggestive of PRES. Two of our patients developed septic shock and deteriorated whereas one patient improved and recovered completely.

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

“…An increasing number of reports have suggested that L-asparaginase administration during ALL treatment is associated with the development of PRES [4,[8][9][10][11]. During chemotherapy for ALL, various types of anticancer drugs are administered, and it is difficult to identify which drug induces PRES.…”

Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

“…It seems that there is a significant female predominance, which may reflect some of the immunological causes of this entity (9). A thorough literature search found that up to now few cases of PRES in children with haematological malignancies have been reported (Table 1) (10)(11)(12)(13)(14)(15)(16)(17). The pathophysiology of PRES remains not only unclear but also enigmatic.…”

False‐photosensitivity and transient hemiparesis following high‐dose intravenous and intrathecal methotrexate for treatment of acute lymphoblastic leukemia

“…Skin symptoms were exacerbated by prior UV exposure, whereas in the CNS there was progressive sensitization with repeat dosing. Such effects were likely not specific to methotrexate since similar drug reactions have been described for other medications [11,12]. Furthermore, PRES is associated with autoimmune disorders [13], suggesting an immune-mediated methotrexate-associated vasculitis.…”