Trastuzumab-associated Posterior Reversible Encephalopathy Syndrome

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic syndrome that presents with neurological manifestations, including seizures, headache, or confusion, and is associated with posterior cerebral white matter edema on imaging. PRES is typically a benign and reversible condition. However, PRES can be fatal or associated with permanent deficits. Numerous conditions are associated with PRES, including hypertensive encephalopathy, renal diseases, and cytotoxic or immunosuppressant drugs. Recently, many case reports described the association between PRES and chemotherapeutic agents. However, trastuzumab-associated PRES is rarely reported. Herein, we report a case of a 51-year-old female with a history of metastatic gastric cancer who developed seizures while being treated with trastuzumab, and neuroimaging confirmed the diagnosis of PRES.

Keywords: gastric cancer; posterior reversible encephalopathy syndrome; trastuzumab.

Figure 1. Brain MRI w/wo contrast. A) T2-TSE sequence, B) T2-FLAIR sequence. Showing bilateral, symmetric areas of T2-FLAIR hyperintensity involving the posterior parietal and occipital lobes. There was no evidence of acute stroke, intracranial hemorrhage, hydrocephalus, dural venous sinuses thrombosis, or intracranial metastatic disease.

T2-TSE: T2-weighted turbo spin echo; T2-FLAIR: T2-weighted-fluid-attenuated inversion recovery.

Figure 2. EGD showing a large malignant looking, friable, fungating, ulcerated mass in the gastric body.

EGD: esophagogastroduodenoscopy.