Neurological variability in chemotherapy‑induced posterior reversible encephalopathy syndrome associated with thrombotic microangiopathy: Case reports and literature review

Makranz,Chen; Khutsurauli,Salome; Kalish,Yosef; Eliahou,Ruth; Kadouri,Luna; Gomori,John  Moshe; Lossos,Alexander

doi:10.3892/mco.2017.1476

Neurological variability in chemotherapy‑induced posterior reversible encephalopathy syndrome associated with thrombotic microangiopathy: Case reports and literature review

Authors:
- Chen Makranz
- Salome Khutsurauli
- Yosef Kalish
- Ruth Eliahou
- Luna Kadouri
- John Moshe Gomori
- Alexander Lossos
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Affiliations: Department of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro‑Oncology, Hadassah‑Hebrew University Medical Center, Jerusalem 91120, Israel, Department of Oncology, Sharet Institute for Oncology, Hadassah‑Hebrew University Medical Center, Jerusalem 91120, Israel, Department of Hematology, Sharet Institute for Oncology, Hadassah‑Hebrew University Medical Center, Jerusalem 91120, Israel, Department of Radiology, Sharet Institute for Oncology, Hadassah‑Hebrew University Medical Center, Jerusalem 91120, Israel
Published online on: November 2, 2017 https://doi.org/10.3892/mco.2017.1476
Pages: 178-182

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Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by headaches, seizures, a confusional state and visual disturbances associated with transient predominantly bilateral posterior white mater magnetic resonance imaging lesions. It is primarily reported in the setting of hypertension, acute renal failure, peripartum eclampsia, autoimmune disease, immunosuppression and chemotherapy. Thrombotic microangiopathy (TMA), including hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) has also been reported as potential PRES inducer. The present study reviews two cases of patients with PRES, associated with TMA caused by chemotherapy. Their clinical and imaging data, and the relevant literature were reviewed. Patient 1 presented with TMA‑induced PRES following mitomycin‑C for metastatic colon adenocarcinoma. Treatment with steroids, plasma exchange, intravenous immunoglobulins, aspirin, antihypertensive drugs, and diuretics resulted in resolution of the neurological and imaging deficits. Patient 2 presented with TMA‑induced PRES following gemcitabine for metastatic breast carcinoma. Treatment was ineffective and the patient deteriorated despite verapamil, dexamethasone, and plasma exchange. In this report, the relevant literature regarding pathogenesis, treatment and prognosis of chemotherapy‑induced PRES associated with TMA was reviewed. We conclude that several chemotherapy agents may cause PRES through various pathogenic mechanisms, leading to clinical variability and divergent response to therapy.

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1	Roth C and Ferbert A: The posterior reversible encephalopathy syndrome: what's certain, what's new? Pract Neurol. 11:136–144. 2011. View Article : Google Scholar : PubMed/NCBI
2	Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL and Caplan LR: A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 334:494–500. 1996. View Article : Google Scholar : PubMed/NCBI
3	Strandgaard S and Paulson OB: Cerebral autoregulation. Stroke. 15:413–416. 1984. View Article : Google Scholar : PubMed/NCBI
4	Ozcan C, Wong SJ and Hari P: Reversible posterior leukoencephalopathy syndrome and bevacizumab. N Engl J Med. 354:980–982; discussion 980–982. 2006. View Article : Google Scholar : PubMed/NCBI
5	Allen JA, Adlakha A and Bergethon PR: Reversible posterior leukoencephalopathy syndrome after bevacizumab/FOLFIRI regimen for metastatic colon cancer. Arch Neurol. 63:1475–1478. 2006. View Article : Google Scholar : PubMed/NCBI
6	Bodkin CL and Eidelman BH: Sirolimus-induced posterior reversible encephalopathy. Neurology. 68:2039–2040. 2007. View Article : Google Scholar : PubMed/NCBI
7	Rajasekhar A and George TJ: Gemcitabine-induced reversible posterior leukoencephalopathy syndrome: a case report and review of the literature. Oncologist. 12:1332–1335. 2007. View Article : Google Scholar : PubMed/NCBI
8	Junna MR and Rabinstein AA: Tacrolimus induced leukoencephalopathy presenting with status epilepticus and prolonged coma. J Neurol Neurosurg Psychiatry. 78:1410–1411. 2007. View Article : Google Scholar : PubMed/NCBI
9	Kozak OS, Wijdicks EF, Manno EM, Miley JT and Rabinstein AA: Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology. 69:894–897. 2007. View Article : Google Scholar : PubMed/NCBI
10	Stott VL, Hurrell MA and Anderson TJ: Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed. Intern Med J. 35:83–90. 2005. View Article : Google Scholar : PubMed/NCBI
11	George JN and Nester CM: Syndromes of thrombotic microangiopathy. New England Journal of Medicine. 371:654–666. 2014. View Article : Google Scholar : PubMed/NCBI
12	Kwon S, Koo J and Lee S: Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Pediatric Neurology. 24:361–364. 2001. View Article : Google Scholar : PubMed/NCBI
13	Bhat RA, Wani Z, Baasit S and Khan I: Clinical course, laboratory parameters and outcome of TTP pediatric patients presenting with posterior reversible encephalopathy syndrome. Renal failure. 37:1–979. 2015. View Article : Google Scholar : PubMed/NCBI
14	Covarrubias DJ, Luetmer PH and Campeau NG: Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. Am J Neuroradiol. 23:1–1048. 2002.PubMed/NCBI
15	Al-Nouri ZL, Reese JA, Terrell DR, Vesely SK and George JN: Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood. 125:1–618. 2015. View Article : Google Scholar : PubMed/NCBI
16	Valavaara R and Nordman E: Renal complications of mitomycin-C therapy with special reference to the total dose. Cancer. 55:1–50. 1985. View Article : Google Scholar : PubMed/NCBI
17	Reese JA, Bougie DW, Curtis BR, Terrell DR, Vesely SK, Aster RH and George JN: Drug-induced thrombotic microangiopathy: Experience of the Oklahoma registry and the BloodCenter of Wisconsin. American Journal of Hematology. 90:406–410. 2015. View Article : Google Scholar : PubMed/NCBI
18	Groff JA, Kozak M, Boehmer JP, Demko TM and Diamond JR: Endotheliopathy: a continuum of hemolytic uremic syndrome due to mitomycin therapy. Am J Kidney Dis. 29:280–284. 1997. View Article : Google Scholar : PubMed/NCBI
19	Mistry B, Kimmel PL, Hetzel PC, Phillips TM and Braden GL: The role of circulating immune complexes and biocompatibility of staphylococcal protein A immunoadsorption in mitomycin-C-induced hemolytic uremic syndrome. Am J Kidney Dis. 44:e50–58. 2004. View Article : Google Scholar : PubMed/NCBI
20	Russell MT, Nassif AS, Cacayorin ED, Awwad E, Perman W and Dunphy F: Gemcitabine-associated posterior reversible encephalopathy syndrome: MR imaging and MR spectroscopy findings. Magn Reson Imaging. 19:129–132. 2001. View Article : Google Scholar : PubMed/NCBI
21	Larsen FO and Hansen SW: Severe neurotoxicity caused by gemcitabine treatment. Acta Oncol. 43:590–591. 2004. View Article : Google Scholar : PubMed/NCBI
22	Govindarajan R, Adusumilli J, Baxter DL, El-Khoueiry A and Harik SI: Reversible posterior leukoencephalopathy syndrome induced by RAF kinase inhibitor BAY 43–9006. J Clin Oncol. 24:e48. 2006. View Article : Google Scholar : PubMed/NCBI
23	How J, Blattner M, Fowler S, Wang-Gillam A and Schindler SE: Chemotherapy-associated posterior reversible encephalopathy syndrome: a case report and review of the literature. The neurologist. 21:112–117. 2016. View Article : Google Scholar : PubMed/NCBI
24	Cherniawsky H, Merchant N, Sawyer M and Ho M: A case report of posterior reversible encephalopathy syndrome in a patient receiving gemcitabine and cisplatin. Medicine. 96:e58502017. View Article : Google Scholar : PubMed/NCBI
25	Bhatt A, Farooq MU, Majid A and Kassab M: Chemotherapy-related posterior reversible leukoencephalopathy syndrome. Nat Rev Neurol. 5:1632009. View Article : Google Scholar
26	Truong QV, Abraham J, Nagaiah G, Newton M and Veltri L: Gemcitabine associated with posterior reversible encephalopathy syndrome (PRES): a case report and review of the literature. Clin Adv Hematol Oncol. 10:611–613. 2012.PubMed/NCBI
27	Kabre RS and Kamble KM: Gemcitabine and Cisplatin induced posterior reversible encephalopathy syndrome: A case report with review of literature. J Res Pharm Pract. 5:297–300. 2016. View Article : Google Scholar : PubMed/NCBI
28	Baker WJ, Royer GL Jr and Weiss RB: Cytarabine and neurologic toxicity. J Clin Oncol. 9:679–693. 1991. View Article : Google Scholar : PubMed/NCBI
29	Ito Y, Arahata Y, Goto Y, Hirayama M, Nagamutsu M, Yasuda T, Yanagi T and Sobue G: Cisplatin neurotoxicity presenting as reversible posterior leukoencephalopathy syndrome. Am J Neuroradiol. 19:415–417. 1998.PubMed/NCBI
30	Beck WT and Kuttesch JF: Neurological symptoms associated with cyclosporin plus doxorubicin. Lancet. 340:4961992. View Article : Google Scholar : PubMed/NCBI
31	Walter RB, Joerger M and Pestalozzi BC: Gemcitabine-associated hemolytic-uremic syndrome. Am J Kidney Dis. 40:e16.1–e16.6. 2002. View Article : Google Scholar
32	Bharthuar A, Egloff L, Becker J, George M, Lohr JW, Deeb G and Iyer RV: Rituximab-based therapy for gemcitabine-induced hemolytic uremic syndrome in a patient with metastatic pancreatic adenocarcinoma: a case report. Cancer Chemother Pharmacol. 64:177–181. 2009. View Article : Google Scholar : PubMed/NCBI
33	Muller S, Schutt P, Bojko P, Nowrousian MR, Hense J, Seeber S and Moritz T: Hemolytic uremic syndrome following prolonged gemcitabine therapy: report of four cases from a single institution. Ann Hematol. 84:110–114. 2005. View Article : Google Scholar : PubMed/NCBI
34	Walter RB, Joerger M and Pestalozzi BC: Gemcitabine-associated hemolytic-uremic syndrome. Am J Kidney Dis. 40:e162002. View Article : Google Scholar : PubMed/NCBI
35	Fung MC, Storniolo AM, Nguyen B, Arning M, Brookfield W and Vigil J: A review of hemolytic uremic syndrome in patients treated with gemcitabine therapy. Cancer. 85:2023–2032. 1999. View Article : Google Scholar : PubMed/NCBI
36	Starck M and Wendtner CM: Use of eculizumab in refractory gemcitabine-induced thrombotic microangiopathy. Br J Haematol. 164:894–896. 2013. View Article : Google Scholar
37	Turner JL, Reardon J, Bekaii-Saab T, Cataland SR and Arango MJ: Gemcitabine-associated thrombotic microangiopathy: response to complement inhibition and reinitiation of gemcitabine. Clin Colorectal Cancer. 16:e119–e122. 2016. View Article : Google Scholar
38	Rogier T, Gerfaud-Valentin M, Pouteil-Noble C, Taleb A, Guillet M, Noel A, Broussolle C and Seve P: Clinical efficacy of eculizumab as treatment of gemcitabine-induced thrombotic microangiopathy: A case report. Rev Med Interne. 37:701–704. 2016. View Article : Google Scholar : PubMed/NCBI
39	Gore EM, Jones BS and Marques MB: Is therapeutic plasma exchange indicated for patients with gemcitabine-induced hemolytic uremic syndrome? J Clin Apher. 24:209–214. 2009. View Article : Google Scholar : PubMed/NCBI
40	Ay H, Buonanno FS, Schaefer PW, Le DA, Wang B, Gonzalez G and Koroshetz WJ: Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology. 51:1369–1376. 1998. View Article : Google Scholar : PubMed/NCBI
41	Lv C and Gao B: Serum lactate dehydrogenase as a predictor of outcome in posterior reversible encephalopathy syndrome: imperative to unify. Am J Neuroradiol. 36:e29–e30. 2015. View Article : Google Scholar : PubMed/NCBI