Duloxetine-related posterior reversible encephalopathy syndrome: A case report

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) has well-established links with several drugs. Whether a link also exists with serotonin-norepinephrine reuptake inhibitor such as duloxetine is unclear.

Methods: We report on a patient who developed PRES with a coma and myoclonus related to hypertensive encephalopathy a few days after starting duloxetine treatment. Magnetic resonance imaging was performed and catecholamine metabolites assayed.

Results: The patient achieved a full recovery after aggressive antihypertensive therapy and intravenous anticonvulsant therapy.

Conclusions: The clinical history, blood and urinary catecholamine and serotonin levels, and response to treatment strongly suggest that PRES was induced by duloxetine. Duloxetine should be added to the list of causes of PRES.

Figure 1

Cerebral imaging in a patient with duloxetine-related PRES. (Panels A and B) No abnormalities 5 days before the onset of PRES. (Panels C and D) FLAIR sequence showing bilateral high-signal foci in the occipital, parietal, and temporal lobes (white arrows). (Panels E and F) FLAIR follow-up sequence showing complete resolution of the abnormalities. FLAIR = fluid-attenuated inversion recovery, PRES = posterior reversible encephalopathy syndrome.

Figure 2

Arterial blood pressure and Glasgow Coma Scale score from the onset of PRES to ICU discharge, according to key PRES management landmarks. ICU = intensive care unit, PRES = posterior reversible encephalopathy syndrome.