title: Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy.
abstract: Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome mostly related to hypertension, eclampsia, renal failure, or to chemotherapy and/or immunosuppressive drugs. Although the PRES pathophysiology is multifactorial, hypertension and endothelial dysfunction are hypothesized to be the pivotal factors. Here we report a case of PRES in an adult patient after chemotherapy (Escherichia coli L-asparaginase [L-ASP], daunorubicin, vincristine, and intrathecal methotrexate) for acute lymphoblastic leukemia. The development of the PRES was strictly associated with an iatrogenic coagulopathy induced by L-ASP, which inhibits the biosynthesis of hepatic coagulation factors. The nadir of platelet count, antithrombin III (ATIII) and fibrinogen curve was coincident with the onset of the PRES neurological picture; subsequently, the normalization of the ATIII and fibrinogen levels seemed to parallel the good clinical evolution. This case seems to provide new insights into the PRES pathophysiological mechanisms.
authors.affiliation: Department of Neurology, Guglielmo da Saliceto Hospital, Castel San Giovanni, Piacenza, Italy.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Rota
authors.affiliation: Department of Hematology, Guglielmo da Saliceto Hospital, Castel San Giovanni, Piacenza, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Vallisa
authors.affiliation: Department of Neurology, Guglielmo da Saliceto Hospital, Castel San Giovanni, Piacenza, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Morelli
authors.affiliation: Department of Radiology, Castel San Giovanni Hospital, Castel San Giovanni, Piacenza, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Scagnelli
keywords: Coagulopathy; L-asparaginase; chemotherapy; posterior reversible encephalopathy syndrome