Reversible posterior leukoencephalopathy syndrome in systemic lupus erythematosus with thrombocytopenia treated with cyclosporine.
Thrombocytopenia is one of the common manifestations of systemic lupus erythematosus (SLE). Its treatment consists of corticosteroids and/or other immunosuppressive drug such as azathioprine, vincristine, cyclosporine, and mycophenolate mofetil. Common adverse reactions of immunosuppressive treatment are infections, hematologic and liver function abnormalities, but neurologic complications may also be seen. Reversible posterior leukoencephalopathy syndrome (RPLS) is a syndrome manifested by headache, nausea, vomiting, seizures, cortical blindness, and visual disturbances. Neuroimaging shows bilateral subcortical and cortical edema with prominent posterior distribution. Moreover, treatment with immunosuppressive drugs such as cyclosporine, cisplatin, tacrolimus, and interferon-alpha can induce a condition resembling RPLS. We report a case of a young woman with SLE and thrombocytopenia, who developed severe perspiration, headache, and seizure after receiving cyclosporine. A brain magnetic resonance image showed multiple high signal intensities on T2-weighted images predominantly located at the parietooccipital lobe. The patient recovered completely clinically and radiologically after discontinuing cyclosporine.
Shin
Ki Chul
KC
Department of Internal Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
Choi
Hyo Jin
HJ
Bae
Yeong Deok
YD
Lee
Jung Chan
JC
Lee
Eun Bong
EB
Song
Yeong Wook
YW
D000328:Adult; D001921:Brain / Q000473:pathology; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000139:chemically induced* / Q000188:drug therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D011239:Prednisolone / Q000627:therapeutic use; D012640:Seizures / Q000139:chemically induced* / Q000188:drug therapy; D013921:Thrombocytopenia / Q000188:drug therapy / Q000209:etiology*; D014750:Vincristine / Q000627:therapeutic use
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014750:Vincristine; D016572:Cyclosporine; D011239:Prednisolone