[Reversible posterior leukoencephalopathy in a patient with non-Hodgkin's lymphoma after treatment with CHOP].
Reversible posterior leukoencephalopathy syndrome is a newly characterised and increasingly recognized clinico-radiologic syndrome. Underlying conditions that reportedly trigger this syndrome include hypertensive encephalopathy, eclampsia, renal failure, and immunosuppressive drug therapy with cyclosporine, tacrolimus and interferon alpha. We describe a 51-year-old woman with non-Hodgkin's lymphoma treated with conventional CHOP chemotherapy. Eight days after this treatment she developed severe headache, bilateral visual loss and focal seizures with secondary generalization. Neurologic examination showed confusion, cortical blindness, and left hemiparesis with hyperreflexia and sensory loss. A cranial T2-weighted magnetic resonance imaging revealed increased signal intensity in the occipital and frontal lobes in both hemispheres and right parietal lobe. A diagnosis of reversible posterior leukoencephalopathy was made. She presented a favourable outcome with conservative treatment with mannitol and phenytoin. A new cranial scanning showed nearly complete resolution of the abnormalities. To the best of our knowledge, this is the first case of reversible posterior leukoencephalopathy in a patient treated with standard-dose CHOP. In this patient, we confirm the theoretical pathophysiologic mechanisms suggested explaining how these drugs can cause the syndrome.
Giménez-Mesa
E
E
Servicio de Neurología, Hospital Universitario Doce de Octubre, Ctra de Andalucía km 5,400, 28041 Madrid.
Martínez-Salio
A
A
Porta-Etessam
J
J
Berbel García
A
A
Cedena Romero
T
T
Salama Bendoyan
P
P
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced*; D003520:Cyclophosphamide / Q000009:adverse effects*; D004317:Doxorubicin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016399:Lymphoma, T-Cell / Q000188:drug therapy*; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects*; D014750:Vincristine / Q000009:adverse effects*
D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone