title: Reversible posterior leukoencephalopathy syndrome associated with concurrent bevacizumab, gemcitabine, and oxaliplatin for cholangiocarcinoma.
abstract: BACKGROUND
  Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare disorder characterized by altered mental status, seizure, hypertension, and symmetrical white matter edema (leukoencephalopathy) typically in the posterior cerebral hemispheres on brain imaging. It is often linked to certain medication use, in particular, chemotherapeutic agents. Here, we present a case of chemotherapy-related RPLS and review the current literature on this topic.
  
  
  METHODS
  We report a case of RPLS associated with concurrent bevacizumab (Avastin), gemcitabine, and oxaliplatin use for unresectable intrahepatic cholangiocarcinoma.
  
  
  CONCLUSIONS
  This is the first reported case of RPLS associated with bevacizumab, gemcitabine, and oxaliplatin combination chemotherapy. Concurrent use of multiple agents could significantly increase the risk of RPLS, a potentially fatal disease. Our case suggests that gradual progression of hypertension and proteinuria may be early warning signs before the onset of RPLS that should alarm clinicians.
authors.affiliation: Department of Medicine, Internal Medicine Residency Program, AtlantiCare Regional Medical Center, Atlantic City, NJ 08401, USA. yongenc@yahoo.com
authors.forename: Yongen
authors.initials: Y
authors.lastname: Chang
authors.forename: Gilbert
authors.initials: G
authors.lastname: Mbeo
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Littman
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000068258:Bevacizumab; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000187:drug effects*; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D011379:Prognosis; D012640:Seizures / Q000139:chemically induced / Q000175:diagnosis; D000093542:Gemcitabine
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000068258:Bevacizumab; D000093542:Gemcitabine