Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Int J Hematol. 2012 Feb;95(2):204-8. doi: 10.1007/s12185-011-0982-9. Epub 2011 Dec 9.
Posterior reversible encephalopathy syndrome (PRES) has been reported in childhood leukemia patients increasingly frequently. However, the development of PRES in adult leukemia patients during chemotherapy is very rare. We present a case of PRES in an adult patient with acute lymphoblastic leukemia (ALL) after remission induction chemotherapy. A 28-year-old woman with ALL was administered remission induction chemotherapy consisting of cyclophosphamide, daunorubicin, vincristine, prednisone, and L-asparaginase. After initiation of chemotherapy, the patient developed paralytic ileus and hypertension, and on day 30, she suddenly developed generalized convulsions, loss of visual acuity, and muscle weakness in the legs. Magnetic resonance imaging findings and her signs and symptoms were typical of PRES. The symptoms gradually improved following treatment with an anticonvulsant and an antihypertensive agent, and the patient underwent allogeneic bone marrow transplantation. She has completely recovered from PRES and has been asymptomatic without leukemia relapse. During remission induction chemotherapy for ALL, PRES may be caused by multiple drugs, such as L-asparaginase, vincristine, and corticosteroids, with different mechanisms of action. PRES should be recognized as an important complication, which will occur more frequently with the increased intensity of chemotherapy for adult ALL patients.
后部可逆性脑病综合征（PRES）在儿童白血病患者中越来越多地被报道。然而，在化疗期间成人白血病患者中 PRES 的发展非常罕见。我们报告了一例缓解诱导化疗后成人急性淋巴细胞白血病（ALL）患者的 PRES 病例。一位 28 岁的 ALL 女性患者接受了包含环磷酰胺、柔红霉素、长春新碱、泼尼松和 L-天冬酰胺酶的缓解诱导化疗。化疗开始后，患者出现麻痹性肠梗阻和高血压，第 30 天，她突然出现全身抽搐、视力丧失和腿部肌肉无力。磁共振成像结果和她的症状和体征均为 PRES 的典型表现。抗癫痫药和降压药治疗后症状逐渐改善，患者接受了异基因骨髓移植。她已完全从 PRES 中恢复，无白血病复发，无症状。在 ALL 的缓解诱导化疗期间，PRES 可能由多种药物引起，如作用机制不同的 L-天冬酰胺酶、长春新碱和皮质类固醇。PRES 应被视为一种重要的并发症，随着成人 ALL 患者化疗强度的增加，其发生率将会更高。
