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Erythropoietin-Associated Posterior Reversible Encephalopathy Syndrome
Jessica Daley White1, Madhurima Anne2, Rajanandini Muralidharan3
1Stony Brook University Renaissance School of Medicine, Stony Brook, NY.
The Neurologist
|May 4, 2021
Summary
Recombinant human erythropoietin (RhEPO) can cause posterior reversible encephalopathy syndrome (PRES), even without kidney issues. Prompt treatment of hypertension and seizures leads to full recovery and normal MRI findings.
Area of Science:
- Neurology
- Nephrology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a neurological condition.
- Essential hypertension is a common comorbidity.
Observation:
- A 51-year-old male with essential hypertension presented with headache and status epilepticus.
- He received recombinant human erythropoietin (RhEPO) for bone marrow suppression, which exacerbated his hypertension.
- Brain MRI revealed diffuse bilateral signal hyperintensities and enhancement, consistent with PRES.
Findings:
- RhEPO treatment precipitated PRES in a patient with no prior renal impairment.
- Hypertension and seizures resolved with treatment, leading to complete neurological recovery.
- Follow-up MRI showed complete normalization of brain imaging findings.
Implications:
- RhEPO is an underrecognized cause of PRES, necessitating consideration in patients receiving this therapy.
- Mechanisms may involve RhEPO-induced hypertension, altered cerebral blood flow, and endothelial dysfunction.
- PRES associated with RhEPO is reversible, with expected symptom and imaging improvement.
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