Cancer Center and Research Institute, University of Mississippi Medical Center Guyton Research Building, MS, USA.
Cancer Center and Research Institute, University of Mississippi Medical Center Guyton Research Building, MS, USA.
Am J Med Sci. 2021 Jun;361(6):795-798. doi: 10.1016/j.amjms.2020.10.030. Epub 2020 Nov 10.
Posterior reversible encephalopathy syndrome (PRES) is a rare clinical-radiographic syndrome that has been expanding rapidly in the world of clinical medical oncology and hematology. In this article, we provide a unique patient case of delayed gemcitabine-induced PRES.
A 60-year-old African American female with significant past medical history of ER+/PR+/HER2- invasive ductal carcinoma of the left breast is seen in the medical oncology clinic with vague, mild complaints of lightheadedness. She had progressed on multiple lines of chemotherapy and was ultimately switched to gemcitabine. One month after her third dose of gemcitabine, she developed acute vision loss and soon developed generalized tonic-clonic seizure. Extensive workup was unrevealing other than PRES and she slowly improved with supportive care and withdrawal of the medication.
Multiple case reports have described PRES in the context of combination chemotherapy with gemcitabine and a platinum agent in the treatment of gastrointestinal malignancies. With growing evidence, this case is consistent with the hypothesis that gemcitabine as monotherapy has a direct association with PRES. This case highlights a unique aspect in that PRES can occur at a delayed time interval, much further than the expected hours to days after the previous treatment.
后部可逆性脑病综合征（PRES）是一种罕见的临床影像学综合征，在临床肿瘤学和血液学领域迅速发展。本文提供了一个独特的吉西他滨诱导的 PRES 迟发病例。
一名 60 岁的非裔美国女性，既往有 ER+/PR+/HER2-左侧乳腺浸润性导管癌病史，在肿瘤内科门诊就诊，诉轻度头晕，症状模糊。她曾接受过多种化疗方案治疗，最终改为吉西他滨。吉西他滨第三疗程后一个月，她出现急性视力丧失，很快出现全面强直阵挛性发作。广泛的检查除 PRES 外无其他发现，她在支持性治疗和停用药物后逐渐好转。
多项病例报告描述了吉西他滨联合铂类药物治疗胃肠道恶性肿瘤的联合化疗中出现 PRES。随着证据的增加，该病例与吉西他滨单药治疗与 PRES 直接相关的假说一致。本例突出了一个独特的方面，即 PRES 可发生在延迟时间间隔，远超过前一次治疗后预期的数小时至数天。
