Antineoplastics

Abstract

Posterior reversible encephalopathy syndrome: case report A 23-year-old woman developed posterior reversible encephalopathy syndrome (PRES) during treatment with gimeracil/oteracil/ tegafur, cisplatin and oxaliplatin for stage 4 advanced gastric carcinoma [routes and dosages not stated]. The woman presented with abdominal distension and anorexia. After subsequent examinations, she was diagnosed with stage 4 advanced gastric carcinoma. She started receiving chemotherapy consisting of gimeracil/oteracil/tegafur [S-1] and cisplatin [CDDP]. However, she subsequently showed acute kidney injury [aetiology not stated]. Her treatment was changed to the SOX regimen containing gimeracil/oteracil/tegafur and oxaliplatin [OHP], of which she received two courses. After the first course, she reported muscle cramps. Examinations showed reduced tumour size and improved mucosal findings. After 78 days of chemotherapy initiation, she experienced a convulsion and required hospital transport in an ambulance. An MRI showed a 15mm round signal at the parietal lobe in T2-weighted image. Brain metastasis were suspected, and she was hospitalised. The woman received unspecified anti-convulsants, which resulted in an improvement in her general muscle cramps. On hospital day 9, she developed consciousness disturbance. Further examinations revealed hyponatraemia and hypertension. Additionally, T2-weighted images showed high-intensity signals in the cerebral white matter on both sides of the occipital lobe. Gimeracil/ oteracil/tegafur-induced leukoencephalopathy was suspected and her SOX regimen was discontinued. She received unspecified anti-hypertensives and electrolyte replenishment. After a few days, her consciousness disturbance improved. A follow-up MRI revealed significant improvement on hospital day 20. She was finally diagnosed with PRES secondary to chemotherapy containing gimeracil/oteracil/tegafur.