Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung Cancer
Posterior reversible encephalopathy syndrome (PRES) is a rare neurological complication that occurs following a sudden blood pressure increase. We report the case of a 64-year-old patient presenting PRES several hours after the administration of a combination of chemotherapy and a checkpoint inhibit...
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| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/6/1369 |
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| author | Cécile Evin Nathalie Lassau Corinne Balleyguier Tarek Assi Samy Ammari |
| author_facet | Cécile Evin Nathalie Lassau Corinne Balleyguier Tarek Assi Samy Ammari |
| author_sort | Cécile Evin |
| collection | DOAJ |
| description | Posterior reversible encephalopathy syndrome (PRES) is a rare neurological complication that occurs following a sudden blood pressure increase. We report the case of a 64-year-old patient presenting PRES several hours after the administration of a combination of chemotherapy and a checkpoint inhibitor (carboplatin-etoposide-atezolizumab) for small-cell lung cancer. He presented consciousness disorders associated with partial epileptic seizure secondarily generalized. His arterial blood pressure was elevated and brain imaging showed multiple bilateral subcortical parietal, temporal, occipital and cerebellar T2 high signals, predominantly in the posterior region. There were no abnormal T1 signals nor bleeding but a left apparent diffusion coefficient restriction was noted. On arterial spin labelling perfusion sequences, there was an increased perfusion within the left temporo-parieto-occipital, left thalamic and right cerebellar regions. Finally, the neurological symptoms completely regressed after several days of optimal antihypertensive and antiepileptic treatment. The clinical context and radiological features, as well as the progressive resolution of the neurological symptoms, were all in favor of PRES. PRES can occur after the administration of chemotherapy and/or immunotherapy. Prompt diagnosis is crucial through a spectrum of suspicious clinical and radiological characteristics that must be rapidly recognized to quickly anticipate the optimal therapeutic strategy and avoid unnecessary complications. |
| first_indexed | 2024-03-09T23:59:56Z |
| format | Article |
| id | doaj.art-000c293dc22d4752b60f684337f0bb79 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T23:59:56Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-000c293dc22d4752b60f684337f0bb792023-11-23T16:17:01ZengMDPI AGDiagnostics2075-44182022-06-01126136910.3390/diagnostics12061369Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung CancerCécile Evin0Nathalie Lassau1Corinne Balleyguier2Tarek Assi3Samy Ammari4Department of Imaging, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, FranceDepartment of Imaging, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, FranceDepartment of Imaging, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, FranceDepartment of Oncology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, FranceDepartment of Imaging, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, FrancePosterior reversible encephalopathy syndrome (PRES) is a rare neurological complication that occurs following a sudden blood pressure increase. We report the case of a 64-year-old patient presenting PRES several hours after the administration of a combination of chemotherapy and a checkpoint inhibitor (carboplatin-etoposide-atezolizumab) for small-cell lung cancer. He presented consciousness disorders associated with partial epileptic seizure secondarily generalized. His arterial blood pressure was elevated and brain imaging showed multiple bilateral subcortical parietal, temporal, occipital and cerebellar T2 high signals, predominantly in the posterior region. There were no abnormal T1 signals nor bleeding but a left apparent diffusion coefficient restriction was noted. On arterial spin labelling perfusion sequences, there was an increased perfusion within the left temporo-parieto-occipital, left thalamic and right cerebellar regions. Finally, the neurological symptoms completely regressed after several days of optimal antihypertensive and antiepileptic treatment. The clinical context and radiological features, as well as the progressive resolution of the neurological symptoms, were all in favor of PRES. PRES can occur after the administration of chemotherapy and/or immunotherapy. Prompt diagnosis is crucial through a spectrum of suspicious clinical and radiological characteristics that must be rapidly recognized to quickly anticipate the optimal therapeutic strategy and avoid unnecessary complications.https://www.mdpi.com/2075-4418/12/6/1369PRESchemotherapyimmunotherapystatus epilepticusdiaschisis |
| spellingShingle | Cécile Evin Nathalie Lassau Corinne Balleyguier Tarek Assi Samy Ammari Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung Cancer Diagnostics PRES chemotherapy immunotherapy status epilepticus diaschisis |
| title | Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung Cancer |
| title_full | Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung Cancer |
| title_fullStr | Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung Cancer |
| title_full_unstemmed | Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung Cancer |
| title_short | Posterior Reversible Encephalopathy Syndrome Following Chemotherapy and Immune Checkpoint Inhibitor Combination in a Patient with Small-Cell Lung Cancer |
| title_sort | posterior reversible encephalopathy syndrome following chemotherapy and immune checkpoint inhibitor combination in a patient with small cell lung cancer |
| topic | PRES chemotherapy immunotherapy status epilepticus diaschisis |
| url | https://www.mdpi.com/2075-4418/12/6/1369 |
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