A Rare Case of Cyclophosphamide-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-GBM Vasculitis, and Review of Current Literature

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome of headache, altered mental status, and seizures with reversible mainly posterior leukoencephalopathy on neuroimaging. Precipitating factors for PRES are multifactorial and include autoregulatory failure due to changes in blood pressure, metabolic derangements, and cytotoxic medications. We report the second case of cyclophosphamide-induced PRES in a patient with anti-glomerular basement membrane (Anti-GBM) positive vasculitis. In the acute setting, PRES can be challenging to distinguish from cerebral venous sinus thrombosis or cerebral vasculitis based on clinical presentation. Neuroimaging with magnetic resonance imaging (MRI) of the brain along with a vessel imaging, can help reach the diagnosis.

Cyclophosphamide‐induced posterior reversible encephalopathy syndrome: A case report

“…Similar to a Korean report of cyclophosphamide‐induced PRES, our patient was hypertensive 8 . However, patients in two other case reports had normotensive PRES 6,7 . Endothelial damage by cyclophosphamide might be the reason for the occurrence of PRES in the setting of normal blood pressure in the aforementioned cases.…”

“…There are few known risk factors for PRES in our patient: renal impairment, 9,10 use of bortezomib, 11‐14 cyclophosphamide, 6‐8 and steroids 15‐17 . In our patient, we believe that the recent use of cyclophosphamide might have contributed to the development of PRES.…”

“…8 However, patients in two other case reports had normotensive PRES. 6,7 Endothelial damage by cyclophosphamide might be the reason for the occurrence of PRES in the setting of normal blood pressure in the aforementioned cases. In all cases of cyclophosphamide-induced PRES, including ours, symptoms resolution occurred within few days of withdrawal of the drug and symptomatic management.…”

“…Posterior reversible encephalopathy syndrome following administration of cytotoxic agents like calcineurin inhibitors, tyrosine kinase inhibitors, oxaliplatin, bevacizumab, and 5‐FU has been commonly reported 4‐6 . Few cases of cyclophosphamide‐induced PRES have also been reported 6‐8 .…”

“…commonly reported. [4][5][6] Few cases of cyclophosphamide-induced PRES have also been reported. [6][7][8] We herein report a case of a 65-year-old woman with multiple myeloma who developed PRES following cyclophosphamide therapy.…”