Posterior reversible encephalopathy syndrome postautologous peripheral stem cell transplantation for multiple myeloma

Abstract

This is a case of a 56-year-old lady with recent autologous peripheral stem cell transplantation for multiple myeloma. She was presented with a 48 h history of worsening headache, drowsiness, nausea/vomiting and some peripheral neurological symptoms. She developed status epilepticus, was intubated and transferred to intensive care unit. After full investigation with a CT head, CT cerebral angiogram, MRI brain and cerebral angiogram, she was diagnosed with posterior reversible encephalopathy syndrome (PRES) with the help of expert opinion, based on the clinical and radiological evidence. The MRI showed bilateral occipital signal changes suggestive of PRES. She was managed with nimodipine, phenytoin and clonazepam with good effect. Eventually extubated, she made good progress on the ward with no further seizure episodes. Functionally she did not appear to have any evidence of residual damage from the PRES. This case discusses PRES on a background of a haematological malignancy and its clinical features.

Posterior reversible encephalopathy syndrome (PRES) and myeloma

“…In multiple myeloma, PRES has only been described in a few cases. It has been reported with Thalidomide [ 2 , 3 ] but mainly with proteasome inhibitors such as Bortezomib [4] , [5] , [6] , [7] , [8] , [9] or Carfilzomib [10] , [11] , [12] , and with autologous stem cell transplantation [13] .…”

“…Four patients developed a PRES shortly after intensification with melphalan followed by autologous stem cell transplantation (ASCT). In the literature, the occurrence of PRES after ASCT is rare but has been previously described [ 13 , 15 ].…”