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Case Report
Posterior reversible encephalopathic syndrome associated with liposomal doxorubicin in a patient with an inoperable desmoid tumor: A case report and review of the literature
1 Basic Physician Trainee, Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
2 Advanced Trainee, Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
3 Consultant, Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Address correspondence to:
Zack Holmes
Peter MacCallum Cancer Centre, Melbourne, Victoria,
Australia
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Article ID: 100105Z10ZH2022
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Holmes Z, Hiong A, Bae S. Posterior reversible encephalopathic syndrome associated with liposomal doxorubicin in a patient with an inoperable desmoid tumor: A case report and review of the literature. J Case Rep Images Oncology 2022;8(1):7–12.ABSTRACT
Introduction: Posterior reversible encephalopathic syndrome (PRES) is a rare diagnosis which presents with seizures, encephalopathy, headache, and/or visual disturbance. Its pathogenesis is not fully understood, but it is often associated with certain chemotherapies, hypertension, and sepsis. Vasogenic edema is the classic radiological feature, while electroencephalogram (EEG) findings are nonspecific. Desmoid tumors are rare, benign growths that arise from connective tissue. There are limited treatment options, but there has been some evidence to suggest that doxorubicin may be effective in reducing tumor size. Doxorubicin is an anthracycline chemotherapy agent frequently used to treat a wide variety of cancers, and has previously been reported to cause PRES when used in combination with other agents.
Case Report: A 33-year-old female presented with six weeks of nausea and abdominal pain on a background history of an inoperable retroperitoneal desmoid tumor. Tumor progression and resulting partial gastric outlet obstruction was confirmed upon admission. Two days after receiving the first dose of liposomal doxorubicin, the patient was found to be agitated and confused with associated hypertension. The patient subsequently had multiple witnessed seizures and was transferred to the intensive care unit (ICU). Seizures resolved with intravenous levetiracetam and subsequent computed tomography (CT) and magnetic resonance imaging (MRI) showed features consistent with PRES. The patient recovered well neurologically and had no further seizures after doxorubicin cessation. The etiology of PRES in this scenario was a probable adverse event to doxorubicin, with hypertension and sepsis as possible contributing factors.
Conclusion: Consider PRES as a cause for new seizures. Systemic doxorubicin and liposomal doxorubicin monotherapy can cause PRES.
Keywords: Adverse event, Desmoid tumor, Doxorubicin, PRES
SUPPORTING INFORMATION
Author Contributions
Zack Holmes - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alison Hiong - Substantial contributions to conception and design, Analysis of data, Final approval of the version to be published
Susie Bae - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Zack Holmes et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
