Ciclosporin
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Posterior reversible encephalopathy syndrome secondary to drug toxicity: case report A 10-year-old boy developed posterior reversible encephalopathy syndrome (PRES) secondary to drug toxicity during immunosuppressive therapy with ciclosporin for the prophylaxis of graft-versus host-disease (GVHD). The boy, who had relapsed acute lymphoblastic leukaemia, underwent an allogenic haemopietic stem cell transplantation (HSCT) in 2017. He started receiving ciclosporin [cyclosporine-A] 3 mg/kg/day [route not stated] for prophylaxis of GVHD one day prior to HSCT. However, 42 days following the HSCT, he presented with a headache, altered mental function and incoherent speech. He was hospitalised. He was disoriented and unable to follow simple commands. In addition, he had visual disturbance manifesting as blurry and reduced vision along with diplopia. Additionally, he reported to have experienced five consecutive acute generalised tonic-clonic convulsions. A brain MRI showed hyperintense signals in the bilateral fronto-parietal and occipital lobes on T2-weighted and fluid-attenuated inversion recovery sequences. Additionally, EEG revealed non-specific slow wave changes. His blood ciclosporin level never exceeded 187 ng/mL; however, ciclosporin toxicity can occur even at normal therapeutic concentration. Based on these findings, he was diagnosed with PRES secondary to ciclosporin toxicity. The boy’s was treated with phenytoin and methylprednisolone. However, he experienced another convulsion one week later. His treatment was then switched from ciclosporin to mycophenolate mofetil. On day 11, clinical findings revealed an improvement in his condition. A brain MRI, 4 weeks later, revealed disappearance of the abnormal signal intensity lesions. Kartal O, et al. Posterior Reversible Encephalopathy Syndrome in a Normotensive Child after Allogeneic Hematopoietic Stem Cell Transplantation. Puerto Rico Health 803500447 Sciences Journal 38: 272-274, No. 4, Dec 2019. Available from: URL: http://prhsj.rcm.upr.edu/index.php/prhsj/article/view/1986
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Reactions 12 Sep 2020 No. 1821
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