The multifactorial origin of posterior reversible encephalopathy syndrome in cyclophosphamide-treated lupus patients

Autor: Mirjana Stanić Benić, Tatjana Zekić, Igor Antončić, Ronald Antulov, Srđan Novak
Rok vydání: 2017
Předmět:
BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences
medicine.medical_specialty
Adolescent
Cyclophosphamide
Immunology
Lupus nephritis
Diagnosis
Differential
03 medical and health sciences
Status Epilepticus
0302 clinical medicine
Pharmacotherapy
Rheumatology
Risk Factors
Internal medicine
Humans
Immunology and Allergy
Medicine
skin and connective tissue diseases
Posterior leukoencephalopathy syndrome · Cyclophosphamide · Systemic lupus erythematosus · Review
030203 arthritis & rheumatology
Systemic lupus erythematosus
business.industry
BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti
Brain
Posterior reversible encephalopathy syndrome
medicine.disease
Lupus Nephritis
Magnetic Resonance Imaging
Treatment Outcome
Posterior Leukoencephalopathy Syndrome
Acute Disease
Female
Differential diagnosis
Tomography
X-Ray Computed
business
Immunosuppressive Agents
030217 neurology & neurosurgery
medicine.drug
Zdroj: Rheumatology International
Volume 37
Issue 12
ISSN: 1437-160X
0172-8172
DOI: 10.1007/s00296-017-3843-x
Popis: The cyclophosphamide as a predisposing factor for Posterior Reversible Encephalopathy Syndrome (PRES) and therapeutic option for systemic lupus erythematosus (SLE) is still confusing. The first and only case of PRES, probably induced by cyclophosphamide, in Croatia followed by the findings of 36 SLE patients diagnosed with PRES after treatment with cyclophosphamide worldwide are described. An 18-year-old Caucasian female patient with a 1-year history of SLE was admitted to the hospital due to lupus nephritis and acute arthritis. After the second dose of cyclophosphamide was administered, according to the Euro-lupus protocol, the patient presented with a grand mal status epilepticus. The differential diagnosis of neurolupus, cerebrovascular insult, and infection were excluded. The MRI findings showed brain changes in corresponding to PRES. The treatment consisted of antihypertensives, antiepileptics, antiedema therapy, mechanical ventilation, and avoiding further cyclophosphamide use. A Naranjo Adverse Drug Reaction Probability Scale total score of five and a probable reaction related to drug therapy (cyclophosphamide, PRES) was confirmed. In this systematic review, along with cyclophosphamide use, the main predisposing factors involved in PRES occurrence in SLE patients were active SLE and renal involvement. Due to the high number of simultaneously involved predisposing factors (max. six) and their overlapping effect, it is still not possible to clearly establish the role of every factor on PRES onset. The use of cyclophosphamide, as a contributing factor for PRES onset, should be carefully assessed, based on clinicians' experience and knowledge, in the setting of active SLE.
Databáze: OpenAIRE
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