Atypical Posterior Reversible Encephalopathy Syndrome due to Oral Tyrosine Kinase Inhibitor Cabozantinib: First Case Report

Patwari, Anannya; Bhatlapenumarthi, Vineel; Pascual, S.

doi:10.1159/000509640

Cited by 8 publications

(5 citation statements)

References 17 publications

(19 reference statements)

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Section: Discussionmentioning

confidence: 85%

“…Previous studies suggested the timing was vague, ranging from weeks to months after initiation of this medication. 6,7 However, the timing of this presentation was similar to that of another TKI, imatinib, which was around 8-12 weeks. 4,5 The prognosis of toxic optic neuropathy varies, depending on the type of drug, drug dose, duration of drug usage, and time of diagnosis.…”

Section: Discussionmentioning

confidence: 86%

“…Endothelial dysfunction from direct injury, leading to dysfunction at the level of the blood-brain barrier with resultant vasogenic edema is a possible explanation. 6 The optic nerve may share the same risk, and that may be another mechanism.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral optic disc edema as a possible complication of cabozantinib use–a case report

Huang

Lin

Tsai

2022

European Journal of Ophthalmology

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Introduction Cabozantinib, which was approved by the Food and Drug Administration (FDA) in 2012, is a tyrosine kinase inhibitor widely used in the treatment of metastatic renal cell carcinoma (RCC) and medullary thyroid carcinoma. To date, no ocular adverse events have been reported by the FDA or on the package label. Here, we described a patient with metastatic RCC who developed bilateral optic disc edema after a 4-month course of cabozantinib. Case description A 55-year-old ethnic Chinese male with RCC with multiple metastases presented to our department with progressive blurred vision in both eyes for 1 month. He started taking cabozantinib 60 mg once daily 5 months prior to this presentation. Poor visual acuity and bilateral disc edema were then noted. Cabozantinib was discontinued after that, and 3-day pulse steroid therapy with methylprednisolone 1 g/day was given. The optic disc edema subsided gradually with limited improvement in visual acuity. Conclusion Bilateral optic edema should be considered as a complication associated with cabozantinib. We propose discontinuation of the treatment in cases such as that, and pulse steroid therapy should be considered if there is no contraindication.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 86%

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Bilateral optic disc edema as a possible complication of cabozantinib use–a case report

Huang

Lin

Tsai

2022

European Journal of Ophthalmology

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“…Two well-documented types of adverse events from these agents that present as encephalopathy are posterior reversible encephalopathy syndrome (PRES) and hyperammonemic encephalopathy. Multiple reports of adverse events related to PRES with the use of TKIs such as sorafenib, sunitinib, pazopanib, and cabozantinib have been reported in the literature, with the hypothesis that their anti-angiogenic properties can increase systemic blood pressure [ 15 ]. The underlying mechanism of TKI-induced hyperammonemic encephalopathy is poorly understood but has been well-documented across multiple therapeutic agents.…”

Section: Discussionmentioning

confidence: 99%

A Case of Non-cirrhotic Hyperammonemic Encephalopathy in a Patient With Metastatic Gastrointestinal Stromal Tumor

Jeong¹,

Abiri²,

Cai³

et al. 2023

Cureus

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Acute toxic encephalopathy (ATE) is a widely recognized medical emergency with an expansive differential. One particular known etiology for ATE is elevated ammonia, a powerful neurotoxin that often presents with clinical findings of confusion, disorientation, tremors, and in severe cases, coma and death. Hyperammonemia is most commonly associated with liver disease and presents as hepatic encephalopathy in the setting of decompensated cirrhosis; however, in rare cases, a patient may suffer from non-cirrhotic hyperammonemic encephalopathy. We describe the case of a 61-year-old male with metastatic gastrointestinal stromal tumor who was diagnosed with non-cirrhotic hyperammonemic encephalopathy, and briefly explore the literature describing its mechanisms.

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“…It is important to identify the underlying triggering factor when PRES is suspected since treatment is generally targeted toward correcting the triggering factor [4]. Chemotherapeutic agents being one of the triggering factors, several of them, as listed in Table 2, have been reported to be responsible for PRES including taxanes, platinum derivatives, vinca alkaloids, antimetabolites, anthracyclines, angiogenesis inhibitors, folate antagonists, and immunosuppressants [6]. However, the exact timeline of initiation of the chemotherapeutic agents and development of PRES has been varied across studies.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome (PRES) in a Patient With Primary Myelofibrosis on Ruxolitinib

Kumar¹,

Nagesh²,

Sivakolundu³

et al. 2021

Cureus

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Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological syndrome characterized by headache, seizures, altered mental status, and visual abnormalities, in association with the characteristic bilateral white matter abnormalities in the posterior cerebral hemispheres. As the name suggests, it is typically reversible with clinical recovery within a few days, while the magnetic resonance imaging (MRI) abnormalities resolve much more slowly. We present a 78-year-old female with a known diagnosis of primary myelofibrosis (PMF), on ruxolitinib, a Janus kinase (JAK) 1 and 2 inhibitor, presenting with altered mental status. On presentation, she was hypertensive and with possible sepsis, secondary to urinary tract infection (UTI). She was intubated because of her low Glasgow Coma Scale (GCS), to secure her airways. Computed tomography (CT) of the brain did not reveal any acute ischemic changes. MRI of the brain exhibited findings suggestive of PRES. Ruxolitinib was held and the patient was treated with antihypertensives, anticonvulsants, and antibiotics. Within 24 hours of hospitalization, the patient had a complete neurological recovery, which is diagnostic of PRES. She was extubated successfully and was discharged with a resolution of her symptoms. Although several chemotherapeutic and immunosuppressant drugs are reported to be associated with PRES, the association between ruxolitinib and PRES has not been well established. Thus, case reporting is important to highlight the possible association between ruxolitinib and PRES.

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Atypical Posterior Reversible Encephalopathy Syndrome due to Oral Tyrosine Kinase Inhibitor Cabozantinib: First Case Report

Cited by 8 publications

References 17 publications

Bilateral optic disc edema as a possible complication of cabozantinib use–a case report

Bilateral optic disc edema as a possible complication of cabozantinib use–a case report

A Case of Non-cirrhotic Hyperammonemic Encephalopathy in a Patient With Metastatic Gastrointestinal Stromal Tumor

Posterior Reversible Encephalopathy Syndrome (PRES) in a Patient With Primary Myelofibrosis on Ruxolitinib

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