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Published on: July 4, 2007
Cyclophosphamide-induced reversible posterior leukoencephalopathy syndrome
Maria Jose Abenza-Abildua1, Blanca Fuentes, Domingo Diaz
1Hospital Universitario La Paz, Neurology, Paseo de la Castellana 261, Madrid, 28046, Spain.
BMJ Case Reports
|June 21, 2011
Summary
This report details a potential case of cyclophosphamide-induced Reversible Posterior Leukoencephalopathy Syndrome (RPLS) in a patient with Goodpasture syndrome. Neurological symptoms resolved after discontinuing cyclophosphamide and controlling hypertension.
Area of Science:
- Neurology
- Nephrology
- Immunology
Background:
- Reversible Posterior Leukoencephalopathy Syndrome (RPLS) is a neurological condition characterized by headache, altered consciousness, seizures, and hypertension.
- Common causes include hypertensive encephalopathy, eclampsia, and immunosuppressive therapies.
- The exact pathogenesis is unknown but involves altered cerebral circulation leading to edema visible on MRI.
Purpose of the Study:
- To report a possible first case of cyclophosphamide-induced RPLS.
- To investigate the link between cyclophosphamide treatment, hypertension, and RPLS in a patient with Goodpasture syndrome.
Main Methods:
- Case report of a 27-year-old male with Goodpasture syndrome, hypertension, and glomerulonephritis.
- Patient was treated with cyclophosphamide and prednisone.
- Clinical presentation, treatment changes, and symptom resolution were monitored.
Main Results:
- The patient developed symptoms consistent with RPLS during a hypertensive crisis while on cyclophosphamide.
- Neurological symptoms resolved after cyclophosphamide was replaced with rituximab and hypertension was controlled.
- This case suggests a potential association between cyclophosphamide and RPLS, particularly in the context of hypertension.
Conclusions:
- Cyclophosphamide may induce Reversible Posterior Leukoencephalopathy Syndrome.
- Controlling hypertension and discontinuing the offending agent (cyclophosphamide) led to symptom resolution.
- Further research is needed to elucidate the specific mechanisms linking immunosuppressive therapy to RPLS.
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