Reactions Weekly | 2021
Tocilizumab
Abstract
Posterior reversible encephalopathy syndrome: case report A 65-year-old woman developed Posterior reversible encephalopathy syndrome (PRES) during treatment with tocilizumab for Giant cell arteritis (GCA). The woman had GCA since 2018 for which she had been receiving prednisolone and SC tocilizumab 162 mg/week since the diagnosis. She was admitted after she suffered a convulsive epileptic seizure in October 2019. She had mild symptoms with a left sided latent sensorimotor hemiparesis and slight cognitive impairment. She had a history of mild hypertension. During transport to hospital she had developed moderate hypertension with blood pressure up to a maximum of 170/90mm Hg. Brain CT showed bilateral distinct occipital hypodense lesions with left sided haemorrhagic features. Brain MRI revealed bilateral extent T2 hyperintense lesions occipital, parietal, frontal and cerebellar without diffusion restriction with the known haemorrhagic changes on the left side. CT-angiography was inconspicuous. Ultrasound showed no signs of active inflammation in the vertebral and temporal arteries. The electroencephalogram revealed bilateral occipital slowing without epileptic activity. The cerebrospinal fluid analysis was unremarkable, without any evidence of JC-virus. The woman was immediately treated with unspecified antihypertensive and levetiracetam. Consequently, she recovered from neurological symptoms within a week, without recurrence of seizures. Based on the clinical findings and changes detected in brain MRI, a diagnosis of PRES was made. The PRES was attributed to tocilizumab [duration of treatment to reaction onset not stated], slightly increased blood pressure values against the background of GCA. Therefore, tocilizumab was discontinued and prednisolone was continued.