Posterior Reversible Encephalopathy Syndrome Secondary to R-CHOP Chemotherapy Regimen

Abstract

Chemotherapy-induced posterior reversible encephalopathy (PRES) syndrome is a rare event. Its recurrence after reusing the incriminated molecules remains unpredictable. We report the case of a 58-year-old female patient being followed for a diffuse large B-cell lymphoma treated with rituximab, cyclophosphamide, hydroxydaunorubicin hydrochloride (doxorubicin hydrochloride), vincristine (Oncovin), and prednisone (R-CHOP) regimen. On the fourth day of the first R-CHOP cycle, the patient suddenly developed a headache, bilateral blurred vision, and drowsiness. The next day (day five), the patient had a spontaneously-resolving generalized tonic-clonic seizure associated with postictal bilateral blindness without any other neurological deficiency. Brain magnetic resonance imaging (MRI) revealed an increased bilateral signal intensity involving the cortex and subcortical white matter of the parietal and occipital lobes on the T2-weighted and the T2-weighted fluid-attenuated inversion recovery (FLAIR), which confirmed the diagnosis of PRES) syndrome. After resolution of symptoms, the continuation of the R-CHOP regimen did not lead to a recurrence of the syndrome.

Keywords: chemotherapy-related toxicity; diffuse large b lymphoma; posterior reversible encephalopathy syndrome (pres); r-chop chemotherapy; rituximab; treatment dilemma.

Figure 1. Coronal plane of brain magnetic resonance imaging (MRI) showing an increased bilateral signal intensity involving the cortex and subcortical white matter of the occipital lobe (Arrows) on the T2-weighted fluid-attenuated inversion recovery (FLAIR).