Reversible posterior leukoencephalopathy syndrome after treatment of diffuse large B-cell lymphoma.
BACKGROUND
We report the case of a patient who experienced a severe neurologic complication after treatment of diffuse large B-cell lymphoma.


METHODS
A 62-year old patient was diagnosed with a diffuse large B-cell lymphoma and treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone under prophylactic G-CSF substitution. After the second cycle she developed severe neurologic complications with generalized seizures and soporous condition. The MRI showed bilateral areas of signal hyperintensity in the subcortical and cortical regions in both hemispheres, consistent with the diagnosis of a reversible posterior leukoencephalopathy syndrome. The patient was under surveillance in intensive care, and a meticulous control of the blood pressure was performed. She fully recovered within a few days, and MRI changes normalized. Antineoplastic treatment had to be continued, and we chose a combination of rituximab, doxorubicin, etoposide, and prednisone.


CONCLUSIONS
The reversible posterior leukoencephalopathy syndrome is believed to be the result of altered cerebral autoregulation with impaired blood flow control and resultant endothelial damage caused by different situations and agents. Several chemotherapy agents have been described in association with the syndrome. However, little is known about the prevalence of the syndrome and the follow-up of these patients, especially their further treatment.
Haefner
Mark D
MD
Institut für med. Onkologie und Hämatologie, Stadtspital Triemli, Zürich, Switzerland. mark.haefner@hin.ch
Siciliano
R Daniele
RD
Widmer
Lucas A
LA
Vogel Wigger
Barbara M
BM
Frick
Sonia
S
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001927:Brain Diseases / Q000139:chemically induced* / Q000175:diagnosis; D002430:Cecal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D002540:Cerebral Cortex / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000139:chemically induced* / Q000175:diagnosis; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000601:surgery; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012075:Remission, Spontaneous