Jayaweera Jayamalee L, Withana Milinda R, Dalpatadu Chamila K P, Beligaswatta Chathurika D, Rajapakse Thamara, Jayasinghe Saroj, Chang Thashi
University Medical Unit, National Hospital, Colombo, Sri Lanka.
J Med Case Rep. 2014 Dec 18;8:442. doi: 10.1186/1752-1947-8-442.
Posterior reversible encephalopathy syndrome is a clinicoradiologic entity characterized by headache, seizures, decreased vision, impaired consciousness and white matter oedema in bilateral occipitoparietal regions. Hypertensive encephalopathy, eclampsia, immunosuppressive/cytotoxic drugs, organ transplantation, renal disease, autoimmune diseases and vasculitides are reported risk factors of posterior reversible encephalopathy syndrome. Reports of cyclophosphamide-induced posterior reversible encephalopathy syndrome are rare and occurred in a background of renal failure, fluid overload or active connective tissue disease.
We report a case of posterior reversible encephalopathy syndrome developing as a direct consequence of intravenous cyclophosphamide therapy in a 33-year-old normotensive Sri Lankan woman with lupus nephritis but quiescent disease activity and normal renal function.
This case report highlights the need for awareness and early recognition of this rare but serious adverse effect of cyclophosphamide that occurred in the absence of other known risk factors of posterior reversible encephalopathy syndrome and that early appropriate intervention leads to a good outcome.
后部可逆性脑病综合征是一种临床放射学实体，其特征为头痛、癫痫发作、视力下降、意识障碍以及双侧枕顶叶区域的白质水肿。高血压脑病、子痫、免疫抑制/细胞毒性药物、器官移植、肾脏疾病、自身免疫性疾病和血管炎是后部可逆性脑病综合征的已知危险因素。环磷酰胺诱发后部可逆性脑病综合征的报道罕见，且多发生于肾衰竭、液体超负荷或活动性结缔组织病的背景下。
我们报告一例33岁血压正常的斯里兰卡女性狼疮性肾炎患者，在疾病活动静止且肾功能正常的情况下，因静脉注射环磷酰胺治疗直接导致后部可逆性脑病综合征。
本病例报告强调，需要认识并早期识别环磷酰胺这种罕见但严重的不良反应，该反应在不存在后部可逆性脑病综合征其他已知危险因素的情况下发生，且早期适当干预可带来良好预后。
