Gemcitabine and cisplatin chemotherapy induced reversible posterior leukoencephalopathy syndrome in a bladder cancer patient

Abstract

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical entity, the common clinical symptoms of which are headache, disturbance of consciousness, altered mental status, seizures, and visual disturbance. Recently, some cases have been reported in association with the increased use of cytotoxic and immunosuppressive agents in cancer patients, and relevant reports have increased with advances in radiological examinations. We describe here the case of a 50-year-old man with advanced bladder cancer who suddenly experienced diminished spontaneity and speech, and finally became semicomatose. Two months previously, he had received gemcitabine and cisplatin chemotherapy. Computed tomography and magnetic resonance imaging revealed symmetrical edema of the posterior occipital lobe and thalamus. Based on these findings, we made a diagnosis of RPLS and treated him with supportive measures. His mental status gradually improved in 2 weeks, although slight neurological symptoms persisted. When the level of consciousness of a cancer patient worsens rapidly, this syndrome should be included in the differential diagnosis and recognized at an early stage. Early supportive management and discontinuation of the causative medication may reverse the clinical and radiological manifestations of the syndrome.

Reversible posterior leukoencephalopathy syndrome following combinatorial cisplatin and pemetrexed therapy for lung cancer in a normotensive patient: A case report and literature review

“…The condition is reported in numerous patients with eclampsia, acute hypertensive encephalopathy associated with renal disease and those receiving immunosuppressive therapy or interferon. An association with cisplatin administration in cancer patients has been widely reported in previous studies (Table I) (5,(16)(17)(18)(19)(20)(21)(22)(23), predominantly occurring within the first 3 cycles of chemotherapy, with the exception of one late-onset case in the 7th cycle (16). In the majority of cases, patients develop hypertension, and additionally present with headaches, seizures, altered mental status and visual disturbances, whilst normotension is only observed in a few cases (5,(16)(17)(18).…”

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

“…There have been 3 published case reports of radiologically proven PRES in patients receiving combination gemcitabine and cisplatin chemotherapy alone despite its widespread use (Table 1 ). [ 7 , 8 , 11 , 16 ] Case reports of PRES induced by gemcitabine with other platinum analogs have also been described as have reports of PRES induced by gemcitabine alone (Table 1 ). [ 21 – 23 ] Connolly et al [ 16 ] described a patient undergoing treatment for nonsmall cell lung cancer with cisplatin 80 mg/m 2 and gemcitabine 1000 mg/m 2 (days unspecified) presenting with seizures, hypertension (184/92 mm Hg), and MRI indicating subcortical occipito-parietal T2 hyperintensities consistent with PRES.…”

“…The patient had normal magnesium levels though IV MgSO 4 was used as a blood pressure control agent with improvement in the patient's condition. Maeda et al [ 7 ] described a patient with urethral carcinoma presenting with GCS of 4 and MRI findings consistent with PRES who was being treated with cisplatin 56 mg/m 2 day 1 and gemcitabine 1000 mg/m 2 days 1, 8, and 15. In comparison to the previous case study, Maeda et al's patient was normotensive and magnesium levels were unreported.…”

“…In comparison to the previous case study, Maeda et al's patient was normotensive and magnesium levels were unreported. [ 7 ]…”

“…[ 1 ] Current hypothesis proposes dysfunctional cerebral vascular auto-regulation leading to a cascade of arteriolar vasodilation, capillary damage, and subsequent cortical and subcortical vasogenic edema as a possible mechanism. [ 2 , 3 , 7 , 9 – 11 , 13 ] It has also been proposed that cytotoxic edema due to chemotherapy induced tumor destruction and subsequent dysfunctional cerebovascular auto-regulation may play an additional role. [ 1 , 2 , 9 ]…”