Cyclophosphamide

Abstract

Posterior reversible encephalopathy syndrome: case report A 65-year-old woman developed posterior reversible encephalopathy syndrome (PRES) during treatment with cyclophosphamide for multiple myeloma. The woman, who had standard risk-multiple myeloma and renal impairment, was receiving bortezomib, lenalidomide and dexamethasone. Following 6 cycles, she developed the extramedullary disease in the oral cavity. She was diagnosed with a progressive disease and was initiated on cyclophosphamide 300 mg/m2 [frequency and route not stated], pomalidomide and dexamethasone. After 4 days, she developed a severe headache, projectile vomiting and blurring of vision. She also developed two episodes of generalised tonic-clonic seizure lasting 4 minutes, at an interval of 45 minutes. She was hospitalised. On examination, she was confused and disoriented. Her GCS was 12/15. Laboratory investigations were performed which revealed elevated blood pressure. MRI of the brain demonstrated increased subcortical signal on axial T2 fluid-attenuated inversion sequences in bilateral parieto-occipital lobes and frontal lobes, with some restricted diffusion in diffusion-weighted imaging. Based on investigational findings and clinical presentation, she was diagnosed with PRES. The woman was treated with levetiracetam, labetalol and amlodipine. All chemotherapeutic drugs were discontinued. Over the next 2 days, her condition improved with some remnant blurring of vision. She was transferred to the observation ward and was discharged 4 days later. After 1 week, she re-initiated chemotherapy except for cyclophosphamide. No recurrence of PRES was observed. She experienced tumour progression and was switched to palliative therapy. However, after a few months, she developed end-stage renal disease and died. The PRES was considered to have developed secondary to cyclophosphamide.