Antineoplastics
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Reactions 1416 - 25 Aug 2012 S Antineoplastics Posterior reversible encephalopathy syndrome: case report A 52-year-old woman developed posterior reversible encephalopathy syndrome (PRES) while receiving antineoplastics. The woman was admitted with precursor B cell acute lymphocytic leukaemia. After peripheral insertion of a central catheter, she started receiving chemotherapy according to the Larson regimen, consisting of prednisone, cyclophosphamide, daunorubicin and vincristine [dosages and routes not stated]. Several hours later, she developed chills, rigor and severe back pain. The following day, blood tests confirmed tumour lysis syndrome. Prednisone was switched to IV methylprednisolone [Solu-Medrol; dosage not stated], and daunorubicin was decreased by 50%. By hospital day 4, her systolic BP had increased to 150mm Hg and her diastolic pressure was 80–90mm Hg. On day 7, she had increased hypertension, with a BP of 170/93mm Hg. The woman received amlodipine, hydralazine and furosemide. After she developed visual hallucinations and lethargy, her concomitant voriconazole therapy was changed to posaconazole, and her analgesic dosages were reduced. She received zolpidem for her insomnia, a frequent adverse effect of steroids, and filgrastim for neutropenia. In her second week of admission, she developed mental status changes, including confusion and disorientation. Zolpidem was stopped, and her analgesics were changed. Despite continuing antihypertensives, her systolic BP remained elevated and her mental status deteriorated. CT revealed hypodensities in the frontal, occipital and parietal lobes, suggestive of a possible PRES diagnosis. She developed a tonic-clonic seizure on day 13, for which she commenced antiepileptic drugs. On day 14, her BP remained dangerously elevated, and a repeat CT scan revealed worsening cerebral oedema. Following an MRI, which confirmed global cerebral oedema, a diagnosis of PRES was validated. During days 14–16, her neurological condition continued to fluctuate. Chemotherapy was discontinued, and she was transferred to an ICU. She received steroids, diuretics, antihypertensives and antiepileptic drugs. By day 17, her seizure activity was controlled, while her mental status had improved. She was transferred from the ICU in her fourth week of admission, and follow-up MRI revealed reduced cerebral oedema. At last follow-up, 2 years after her initial diagnosis, she had completed chemotherapy according to the protocol, and had no residual effects of PRES. Author comment: "[CT] findings suggested a possible diagnosis of posterior reversible encephalopathy syndrome (PRES), brought on by chemotherapeutic agents or intracranial involvement by malignancy. . . chemotherapy was discontinued, since any of the medications could have been the causative pharmacologic agent". Wright KL, et al. Posterior reversible encephalopathy syndrome: a case study. American Journal of Nursing 112: 36-40, No. 5, May 2012. Available from: URL: http://journals.lww.com/ajnonline/toc/2012/05000 - USA 803075861 1 Reactions 25 Aug 2012 No. 1416 0114-9954/10/1416-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1416 - 25 Aug 2012
SAntineoplastics
Posterior reversible encephalopathy syndrome:case report
A 52-year-old woman developed posterior reversibleencephalopathy syndrome (PRES) while receivingantineoplastics.
The woman was admitted with precursor B cell acutelymphocytic leukaemia. After peripheral insertion of acentral catheter, she started receiving chemotherapyaccording to the Larson regimen, consisting of prednisone,cyclophosphamide, daunorubicin and vincristine [dosagesand routes not stated]. Several hours later, she developedchills, rigor and severe back pain. The following day, bloodtests confirmed tumour lysis syndrome. Prednisone wasswitched to IV methylprednisolone [Solu-Medrol; dosagenot stated], and daunorubicin was decreased by 50%. Byhospital day 4, her systolic BP had increased to 150mm Hgand her diastolic pressure was 80–90mm Hg. On day 7, shehad increased hypertension, with a BP of 170/93mm Hg.
The woman received amlodipine, hydralazine andfurosemide. After she developed visual hallucinations andlethargy, her concomitant voriconazole therapy waschanged to posaconazole, and her analgesic dosages werereduced. She received zolpidem for her insomnia, afrequent adverse effect of steroids, and filgrastim forneutropenia. In her second week of admission, shedeveloped mental status changes, including confusion anddisorientation. Zolpidem was stopped, and her analgesicswere changed. Despite continuing antihypertensives, hersystolic BP remained elevated and her mental statusdeteriorated. CT revealed hypodensities in the frontal,occipital and parietal lobes, suggestive of a possible PRESdiagnosis. She developed a tonic-clonic seizure on day 13,for which she commenced antiepileptic drugs. On day 14,her BP remained dangerously elevated, and a repeat CTscan revealed worsening cerebral oedema. Following anMRI, which confirmed global cerebral oedema, a diagnosisof PRES was validated. During days 14–16, her neurologicalcondition continued to fluctuate. Chemotherapy wasdiscontinued, and she was transferred to an ICU. Shereceived steroids, diuretics, antihypertensives andantiepileptic drugs. By day 17, her seizure activity wascontrolled, while her mental status had improved. She wastransferred from the ICU in her fourth week of admission,and follow-up MRI revealed reduced cerebral oedema. Atlast follow-up, 2 years after her initial diagnosis, she hadcompleted chemotherapy according to the protocol, andhad no residual effects of PRES.
Author comment: "[CT] findings suggested a possiblediagnosis of posterior reversible encephalopathy syndrome(PRES), brought on by chemotherapeutic agents or intracranialinvolvement by malignancy. . . chemotherapy wasdiscontinued, since any of the medications could have beenthe causative pharmacologic agent".Wright KL, et al. Posterior reversible encephalopathy syndrome: a case study.American Journal of Nursing 112: 36-40, No. 5, May 2012. Available from: URL:http://journals.lww.com/ajnonline/toc/2012/05000 - USA 803075861
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Reactions 25 Aug 2012 No. 14160114-9954/10/1416-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
