title: Reversible posterior leukoencephalopathy syndrome induced by bevacizumab plus chemotherapy in colorectal cancer.
abstract: Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare brain-capillary leak syndrome, characterized by clinical symptoms of headache, visual loss, seizures and altered mental functioning. This syndrome is usually reversible and is associated with hypertension, nephropathy, and use of immunosuppressive medication and cytotoxic agents. We describe two rare cases of RPLS occurring in colorectal cancer, both of which presented with coma, that we believe can be directly attributed to bevacizumab, a monoclonal antibody that inhibits the angiogenesis of tumours by specifically blocking vascular endothelial growth factor. We analysed the clinical features, risk factors and outcomes of RPLS in these two patients, and although no typical finding was identified on imaging examination, we found that inadequate blood pressure control was one of the risk factors leading to RPLS and that supportive treatment including intensive blood pressure control improved outcomes. Due to the increasing use of bevacizumab in colorectal cancer, clinicians should be aware of this potential complication.
authors.affiliation: Wei Wang, Li-Rong Zhao, Xiu-Qiang Lin, Fen Feng, Department of Gastroenterology, Foshan First People's Hospital, Foshan 520800, Guangdong Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Wei Wang, Li-Rong Zhao, Xiu-Qiang Lin, Fen Feng, Department of Gastroenterology, Foshan First People's Hospital, Foshan 520800, Guangdong Province, China.
authors.forename: Li-Rong
authors.initials: LR
authors.lastname: Zhao
authors.affiliation: Wei Wang, Li-Rong Zhao, Xiu-Qiang Lin, Fen Feng, Department of Gastroenterology, Foshan First People's Hospital, Foshan 520800, Guangdong Province, China.
authors.forename: Xiu-Qiang
authors.initials: XQ
authors.lastname: Lin
authors.affiliation: Wei Wang, Li-Rong Zhao, Xiu-Qiang Lin, Fen Feng, Department of Gastroenterology, Foshan First People's Hospital, Foshan 520800, Guangdong Province, China.
authors.forename: Fen
authors.initials: F
authors.lastname: Feng
mesh_terms: D015746:Abdominal Pain; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000068258:Bevacizumab; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003128:Coma / Q000139:chemically induced; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009362:Neoplasm Metastasis; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D000068258:Bevacizumab
keywords: Bevacizumab; Colorectal cancer; Coma; Hypertension; Reversible posterior leukoencephalopathy syndrome