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Case Report
Posterior reversible encephalopathy syndrome presenting as acute blindness
1 Assistant Professor, Department of Internal Medicine, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida, USA
2 Physician Assistant, Department of Internal Medicine, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida, USA
3 Professor, Department of Radiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida, USA
4 Assistant Professor, Department of Neurology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida, USA
5 Chair of Medicine, Associate Professor, Department of Internal Medicine, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida, USA
Address correspondence to:
Dinesh Keerty
MD, FACP, 12902 USF Magnolia Drive, Moffitt Cancer Center, Dept-IHM, Tampa, Florida 33612,
USA
Message to Corresponding Author
Article ID: 101130Z01DK2020
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Keerty D, Haynes E, Eaton K, Arrington J, Peguero E, Ramsakal A. Posterior reversible encephalopathy syndrome presenting as acute blindness. Int J Case Rep Images 2020;11:101130Z01DK2020.ABSTRACT
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin lymphoma (NHL) accounting for approximately 25–30% of NHL cases. The treatment is based upon stage and extent of disease. In most cases, NHL is treated with systemic chemotherapy and sometimes also radiation. As it is well known, there are numerous side effects to chemotherapy that includes rituximab. We are here to present one rare side effect of treatment called posterior reversible encephalopathy syndrome (PRES).
Case Report: This is a 67-yearold female patient with diffuse large B-cell lymphoma with extensive neoplastic involvement of the lower thorax, abdomen, pelvis, and bilateral hydronephrosis with diffuse tumor infiltration of the left renal hilum. She was started on aggressive chemotherapy with dose adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, rituximab (DAEPOCH- R). She was also being treated with intrathecal chemotherapy with methotrexate (MTX). She presented to the emergency room with generalized weakness, confusion, and fevers. She started complaining of loss of vision in the emergency room. A quick ophthalmic examination showed that her pupils were round, regular, and reactive to light with no gross deficits. Computed tomography (CT) of the head demonstrated bilateral, symmetrical vasogenic edema in the right and left posterior frontoparietal and occipital cortices and cerebellar hemispheres. Magnetic resonance imaging (MRI) of the brain showed vasogenic edema in the cerebellum and parieto-occiptal lobes with no restricted diffusion consistent with PRES.
Conclusion: Posterior reversible encephalopathy syndrome can result from various etiologies of which hypertensive encephalopathy, thrombotic thrombocytopenic purpura, and eclampsia are common. This case serves to raise awareness among hospitalists that PRES should be a differential diagnosis in the setting of patients receiving certain chemotherapeutic agents presenting with the aforementioned clinical symptoms.
Keywords: Adverse effects, Chemotherapy, Encephalopathy, Hypertension, Lymphoma
SUPPORTING INFORMATION
Author Contributions
Dinesh Keerty - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Elizabeth Haynes - Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Kevin Eaton - Acquisition of data, Analysis of data, Drafting the article, Final approval of the version to be published
John Arrington - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Edwin Peguero - Acquisition of data, Analysis of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Asha Ramsakal - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Dinesh Keerty et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
