Posterior reversible encephalopathy syndrome during treatment with tocilizumab in juvenile idiopathic arthritis

Abstract

A 17-year-old man with normal blood pressure presented with acute bilateral blindness, and retro-orbital pain two days after treatment with tocilizumab (TCZ) for juvenile idiopathic arthritis. The diagnosis was posterior reversible encephalopathy syndrome (PRES), made after clinical examination and MRI (Figure). Tocilizumab was discontinued and the patient partially improved. To the best of our knowledge, there are no reports of this association (PRES and TCZ) in PubMed. This manuscript describes a new association between TCZ and PRES based on imaging findings, in which the patient presented with more severe imaging findings and did not have complete recovery of the symptoms 1,2,3 .

Posterior reversible encephalopathy syndrome (PRES) as a neurological association in severe Covid-19

“…Further supporting an endothelial dysfunction process, one of our patients received tocilizumab, which is known to have endothelial modulation properties and has been previously reported in association with PRES. [4] We have had on average 1.4 cases of PRES per year over the past 5 years (January 2015 to December 2019) in our hospital. The two patients described here were diagnosed in the same week, 3 weeks after the plateau of COVID-19 cases in our hospital.…”

Posterior Reversible Encephalopathy Syndrome in Patients with Coronavirus Disease 2019: Two Cases and A Review of The Literature

“… 18 , 19 , 20 In particular, the interleukin-6 inhibitor tocilizumab has been described in association with PRES. 21 Our findings suggest that caution may be warranted when considering interleukin inhibitors to treat COVID-19 in patients with underlying PRES risk factors, that anakinra may also be associated with an increased risk of PRES in patients with COVID-19, and that these agents should be discontinued if PRES is diagnosed.…”

Posterior Reversible Encephalopathy Syndrome in a Patient With SARS-CoV-2 Infection Treated With Tocilizumab

“…However, a rare yet potential complication of this immunomodulating drug may be PRES as well. A tocilizumab-associated PRES has been reported in a patient with juvenile idiopathic arthritis [13].…”