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[Malignant lymphoma complicated with posterior reversible encephalopathy]
Rasmus Heje Thomsen1, Kristine Zakarian, Per Boye Hansen
1pbhn@regionsjaelland.dk.
Ugeskrift for Laeger
|September 17, 2015
Summary
A patient developed posterior reversible encephalopathy syndrome (PRES) with seizures after R-ICE chemotherapy for lymphoma. This is the first reported case linking R-ICE treatment to PRES, highlighting a potential adverse effect.
Area of Science:
- Neurology
- Oncology
- Pharmacology
Background:
- Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma.
- Chemotherapy regimens like R-ICE (rituximab, ifosfamide, carboplatin, etoposide) are used for relapsed DLBCL.
- Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by headache, seizures, and visual disturbances.
Observation:
- A 56-year-old woman with relapsed DLBCL received R-ICE chemotherapy.
- Twenty-seven days post-treatment, she developed generalized seizures and PRES.
- MRI confirmed PRES with cerebral edema in the occipital, parietal, and frontal lobes.
Findings:
- The patient had moderate renal impairment but normal blood pressure.
- PRES symptoms resolved with full remission on follow-up MRI after four weeks.
- This case represents the first documented instance of R-ICE chemotherapy inducing PRES.
Implications:
- The R-ICE regimen may be associated with an increased risk of PRES, particularly in patients with renal impairment.
- Awareness of this potential adverse effect is crucial for oncologists and neurologists managing DLBCL patients.
- Further investigation into the mechanisms linking R-ICE and PRES is warranted to optimize patient safety.
