title: Recurrent posterior reversible encephalopathy syndrome after chemotherapy in hematologic malignancy-posterior reversible encephalopathy syndrome can strike twice!!!
abstract: Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological syndrome characterized by seizures, altered level of consciousness, visual disturbance, and hyperintense lesions on magnetic resonance imaging most commonly in the posterior regions. PRES is typically associated with a number of complex clinical conditions including: Preeclampsia/eclampsia, allogeneic bone marrow transplantation, solid organ transplantation, autoimmune diseases, and high-dose anti-neoplastic therapy. We herein describe a case of recurrent PRES in a 29-year-old lady of refractory anaplastic large-cell lymphoma who was on second-line chemotherapy with Ifosfamide-Carboplatin-etoposide regimen. We have also tried to illustrate the pathogenesis, radiological features, and management of PRES. Although reversible in most cases, PRES may be recurrent even in chemotherapy--induced cases and result in fatal outcomes despite appropriate intervention. This is the first--reported case of recurrent PRES with such a fatal outcome, as a complication of anti-neoplastic systemic therapy.
authors.affiliation: Department of Radiation Oncology, Institute Rotary Cancer Hospital, AIIMS, New Delhi, India.
authors.forename: Soumyajit
authors.initials: S
authors.lastname: Roy
authors.forename: Ajeet K
authors.initials: AK
authors.lastname: Gandhi
authors.forename: Manisha
authors.initials: M
authors.lastname: Jana
authors.forename: Pramod K
authors.initials: PK
authors.lastname: Julka
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D017728:Lymphoma, Large-Cell, Anaplastic / Q000188:drug therapy*; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced / Q000175:diagnosis*; D011239:Prednisolone / Q000008:administration & dosage; D016879:Salvage Therapy; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D016190:Carboplatin; D007069:Ifosfamide