Antineoplastics
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Reactions 1427 - 10 Nov 2012 S Antineoplastics Atypical reversible posterior leukoencephalopathy syndrome: case report A 62-year-old woman developed atypical reversible posterior leukoencephalopathy syndrome (RPLS) following antineoplastic therapy for acute lymphoblastic leukaemia (ALL). The woman received a chemotherapy regimen comprising cyclophosphamide, vincristine, doxorubicin and prednisolone [dosages and routes not stated]. She experienced febrile neutropenia 9 days after initiating chemotherapy for which antibiotic and antifungal agents were administered. Subsequently, she developed Stevens- Johnson syndrome (SJS) which was treated with high-dose methylprednisolone. Hyponatraemia also became apparent as a consequence of chemotherapy [time to reaction onset not stated]. Her erythroderma and hyponatraemia gradually improved. She subsequently became febrile and her level of consciousness decreased preceding a sudden fall. She received further antibiotic therapy for sepsis and her level of consciousness improved. Subsequently, she lost consciousness accompanied by elevated blood pressure [time to reaction onset not stated]. A brain CT scan revealed multiple low-density areas in the thalamus, midbrain and pons. A brain MRI showed multiple high signal intensity lesions with small haemorrhagic areas. She was diagnosed with haemorrhage in atypical RPLS. After completion of treatment for sepsis and control of blood pressure the woman fully regained consciousness. Repeat brain MRI after 2 months showed no RPLS lesions. She underwent 4 months of rehabilitation prior to being discharged. Complete remission of ALL was achieved. Author comment: "In the present case, brain MRI revealed the presence of RPLS lesions in the occipital lobe, midbrain, pons and thalami with minute hemorrhage... [W]e consider that these lesions were caused by multiple factors, including SJS, sepsis, hyponatremia, hypertension and chemotherapeutic agents". Kamezaki M, et al. Reversible posterior leukoencephalopathy syndrome of bilateral thalamus in acute lymphoblastic leukemia. Leukemia and Lymphoma 53: 2083-2084, No. 10, Oct 2012. Available from: URL: http:// dx.doi.org/10.3109/10428194.2012.673227 - Japan 803079635 1 Reactions 10 Nov 2012 No. 1427 0114-9954/10/1427-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1427 - 10 Nov 2012
SAntineoplastics
Atypical reversible posteriorleukoencephalopathy syndrome: case report
A 62-year-old woman developed atypical reversibleposterior leukoencephalopathy syndrome (RPLS) followingantineoplastic therapy for acute lymphoblastic leukaemia(ALL).
The woman received a chemotherapy regimencomprising cyclophosphamide, vincristine, doxorubicinand prednisolone [dosages and routes not stated]. Sheexperienced febrile neutropenia 9 days after initiatingchemotherapy for which antibiotic and antifungal agentswere administered. Subsequently, she developed Stevens-Johnson syndrome (SJS) which was treated with high-dosemethylprednisolone. Hyponatraemia also becameapparent as a consequence of chemotherapy [time toreaction onset not stated]. Her erythroderma andhyponatraemia gradually improved. She subsequentlybecame febrile and her level of consciousness decreasedpreceding a sudden fall. She received further antibiotictherapy for sepsis and her level of consciousness improved.Subsequently, she lost consciousness accompanied byelevated blood pressure [time to reaction onset not stated].A brain CT scan revealed multiple low-density areas in thethalamus, midbrain and pons. A brain MRI showed multiplehigh signal intensity lesions with small haemorrhagic areas.She was diagnosed with haemorrhage in atypical RPLS.
After completion of treatment for sepsis and control ofblood pressure the woman fully regained consciousness.Repeat brain MRI after 2 months showed no RPLS lesions.She underwent 4 months of rehabilitation prior to beingdischarged. Complete remission of ALL was achieved.
Author comment: "In the present case, brain MRI revealedthe presence of RPLS lesions in the occipital lobe, midbrain,pons and thalami with minute hemorrhage... [W]e considerthat these lesions were caused by multiple factors, includingSJS, sepsis, hyponatremia, hypertension andchemotherapeutic agents".Kamezaki M, et al. Reversible posterior leukoencephalopathy syndrome of bilateralthalamus in acute lymphoblastic leukemia. Leukemia and Lymphoma 53:2083-2084, No. 10, Oct 2012. Available from: URL: http://dx.doi.org/10.3109/10428194.2012.673227 - Japan 803079635
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Reactions 10 Nov 2012 No. 14270114-9954/10/1427-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
