Reactions 1680, p256 - 2 Dec 2017 Posterior reversible encephalopathy syndrome: case report A 47-year-old woman developed posterior reversible encephalopathy syndrome (PRES) following the therapy with The woman had an ongoing history of metastatic, poorly differentiated lung cancer with neuroendocrine features. She was hospitalised after 4 days of nausea, vomiting, disorientation and one episode of generalised tonic clonic seizure. Examinations on presentation showed the following: BP 148/95mm Hg, HR 95 bpm and body temperature 36.4°C. She was encephalopathic and had cortical blindness. A brain MRI without contrast was performed, which revealed changes, consistent with PRES. It was then revealed that she received two doses of nivolumab; the last dose administered was 24 days before the onset of this manifestation [dosage and route not stated]. The woman received supportive care treatment. Subsequently, her mental state returned to baseline. Her vision also stabilised after a few weeks. However, she developed seizure disorder with a focal onset in the form of stereotyped visual hallucinations of primary colours in a geometrical arrangement and secondary generalisation. A Repeat MRI with contrast were performed after 3 and 9 months, which revealed incomplete resolution of PRES lesions, with residual cortical/subcortical non-enhancing gliosis seen in bilateral occipital poles and left frontotemporal area. Author comment: "She had been on nivolumab, of which she had received 2 doses; the last dose was 24 days before the onset of this illness. She had not received any other cancer-directed therapy for 6 months. She did not have any other cause of PRES (pregnancy, severe hypertension, sepsis)." Hussein HM, et al. Nivolumab-induced posterior reversible encephalopathy syndrome. Neurology: Clinical Practice 7: 455-456, No. 5, Oct 2017. Available from: URL: http://doi.org/10.1212/CPJ.0000000000000362 - USA 803284854 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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