Posterior reversible encephalopathy syndrome in immunocompromised children - A single-center study from South India

Abstract

This study describes the profile of children diagnosed with posterior reversible encephalopathy syndrome (PRES) in the pediatric hematology oncology unit and highlights the clinical features of PRES in immunosuppressed children. This retrospective study included 10 children diagnosed with PRES with a mean age of 6.8 years. Acute lymphoblastic leukemia was the most common primary diagnosis followed by post-hematopoietic stem cell transplant patients. Most cases of PRES occurred within one month of treatment initiation. Hypertension was noted in all at the time of diagnosis. Neuroimaging revealed bilateral lesions with parietal and occipital lobe involvement being the most common. All patients received corticosteroids as part of treatment for primary diagnosis. Controlling blood pressure was critical in managing PRES. Consideration of PRES as a clinical possibility in pediatric hematology oncology unit in children presenting with symptoms such as headache, seizures, and visual disturbances will aid in early diagnosis after ruling out other causes of these symptoms.

Keywords: Childhood cancer; Hematopoietic stem cell transplantation; Hypertension; Immunocompromised host; Pediatric hematology-oncology unit; Posterior reversible encephalopathy syndrome.

Figure 1:

Symptoms at presentation.

Figure 2:

Five-year-old girl with intracranial non-germinomatous germ cell tumor of suprasellar region who presented with visual disturbances and altered sensorium, magnetic resonance imaging image shows bilateral symmetrical T2/fluid-attenuated inversion recovery hyperintensities (arrows) with subtle restricted diffusion is seen in bilateral parieto-occipital lobes and bilateral cerebellar hemispheres, suggestive of posterior reversible encephalopathy syndrome. In the coronal flair, bilateral optic nerve sheath complexes appear prominent with mild kinking of optic nerves, suggestive of raised intracranial tension.