A case report of posterior reversible encephalopathy syndrome in a patient receiving gemcitabine and cisplatin

Abstract

Rationale:Posterior reversible encephalopathy syndrome (PRES) is a subacute syndrome causing characteristic neurologic and radiologic findings. PRES is predominantly caused by malignant hypertension though it has been associated with immunosuppressive treatments such as chemotherapy.Patient Concerns:We describe a case of a 58 year old female who developed fluctuant level of consciousness, agitation.Diagnosis:MRI findings were in keeping with posterior reversible encephalopathy syndrome following cycle 6 of palliative gemcitabine and cisplatin therapy for metastatic cholangiocarcinoma.Interventions:The patient was managed with magnesium supplementation for hypomagnesemia and amlodipine.Outcomes:The patient's level of consciousness returned to normal though she had residual neurologic deficits impairing her ability to drive and impacting her balance.Conclusions:Cisplatin is a documented causative agent of PRES though gemcitabine is rarely associated with the syndrome. Combination cisplatin and gemcitabine therapy causing radiologically proven PRES has been documented in only 3 previous case reports. Gemcitabine's poor blood-brain barrier penetration makes it an unlikely culprit of central nervous system (CNS) toxicities. Our case and previous reports suggest higher doses may contribute to CNS toxicities such as PRES. Additionally, an emerging trend of hypomagnesemia associated with PRES has been documented inside and outside the context of malignancy and suggests a possible target for treatment and prevention warranting further investigation.

Differential expression profile analysis of cisplatin‑regulated miRNAs in a human gastric cancer cell line

“…cisplatin is associated with dose-dependent side effects (5,6), including gastrointestinal reactions (7), bone marrow suppression (8), liver and kidney damage (9), ototoxicity (10) and neurotoxicity (11). renal toxicity is frequently encountered, with a clinical incidence rate of 25-35% (12)(13)(14). The side effects associated with cisplatin have limited its use and clinical efficacy (15,16).…”

Posterior reversible encephalopathy syndrome associated with the use of chemotherapeutic agents: a rare complication after treatment with vinorelbine

“…In our case, vinorelbine was considered the likely causal agent because of a closer temporal association between vinorelbine administration and PRES (12 hours), rather than cisplatin (1 week) 6. Nevertheless, we cannot rule out the contribution of cisplatin for PRES, especially because previous case reports have found delayed PRES 1 and 2 weeks after cisplatin cycles, usually in association with other chemotherapeutic agents such as pemetrexed and gemcitabine 18–20 27 28. Cisplatin-induced PRES is therefore rare and it most likely requires a second leucotoxic agent 18.…”

Posterior reversible encephalopathy syndrome (PRES) in a patient with complicated appendicitis. A case report

“…Posterior reversible encephalopathy syndrome (PRES) first described by Hinchey J et al in 1996 is a reversible neurological condition characterized by seizures, impaired consciousness and visual defecit with a typical radiologic findings on computed tomographic (CT) and magnetic resonance imaging (MRI) of brain. [1][2][3][4][5][6] There are described risk factors associated with developing this clinical syndrome, typically occurring mostly in females across all ages, ranging from 4-90years of age, 3 with renal disease, hypertension in pregnancy and as seen in patients on immune suppresive therapies. 6 It is also thought to follow a hypovolaemic episode in infection, sepsis, autoimmune disease and electrolyte abnormalities in septic shock.…”

“…[1][2][3][4][5][6] There are described risk factors associated with developing this clinical syndrome, typically occurring mostly in females across all ages, ranging from 4-90years of age, 3 with renal disease, hypertension in pregnancy and as seen in patients on immune suppresive therapies. 6 It is also thought to follow a hypovolaemic episode in infection, sepsis, autoimmune disease and electrolyte abnormalities in septic shock. Ourpatient, a young lady with septic shock from complicated appendicitis, peri-operatively developed PRES as evidenced by generalized tonic-clonic seizures and vision lossand typical radiologic pictures.…”