title: [Development of syndrome of inappropriate secretion of ADH and reversible posterior leukoencephalopathy during initial rituximab-CHOP therapy in a patient with diffuse large B-cell lymphoma].
abstract: A 61-year-old woman presented with a right mandibular tumor and was diagnosed with DLBCL clinical stage IIIA from the biopsy results of the tumor and CT examination. An initial rituximab was administrated a week after the first CHOP treatment. During the infusion of rituximab, she exhibited disorientation, seizure, and consciousness disturbance. Hyponatremia due to SIADH and hypertension were coincidentally observed. MRI revealed T2 and FLAIR hyperintense signals involving the bilateral occipital, parietal, frontal lobes and the cerebellum that were consistent with reversible posterior leukoencephalopathy syndrome (RPLS). Her consciousness level recovered in parallel with corrections in serum sodium levels and blood pressure. Although she presented with transient cortical blindness, all neurological abnormalities disappeared 40 hours after the occurrence of seizure. She received a further 7 cycles of CHOP followed by 7 cycles of rituximab treatment with no relapse of RPLS. After irradiation for a residual abdominal tumor, she has maintained complete remission for 2 years. Although RPLS is a rare complication of rituximab-CHOP chemotherapy, it should be considered in patients with DLBCL who present with acute neurological deterioration.
authors.affiliation: Department of Internal Medicine, Matsusaka Chuo General Hospital, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Mizutani
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nakamori
authors.forename: Haruna
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kageyama
authors.forename: Eiko
authors.initials: E
authors.lastname: Oya
authors.forename: Kazuko
authors.initials: K
authors.lastname: Ino
authors.forename: Kei
authors.initials: K
authors.lastname: Suzuki
authors.forename: Takao
authors.initials: T
authors.lastname: Sekine
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009481:Neurophysins / Q000378:metabolism*; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011241:Prednisone / Q000008:administration & dosage; D011498:Protein Precursors / Q000378:metabolism*; D000069283:Rituximab; D014667:Vasopressins / Q000378:metabolism*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: C438657:AVP protein, human; D058846:Antibodies, Monoclonal, Murine-Derived; D009481:Neurophysins; D011498:Protein Precursors; D014667:Vasopressins; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone