Posterior reversible encephalopathy syndrome (PRES) caused by chemotherapy containing S-1 against diffuse type gastric c
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CASE REPORT
Posterior reversible encephalopathy syndrome (PRES) caused by chemotherapy containing S‑1 against diffuse type gastric cancer Masashi Yokota1 · Takayuki Shirai1 · Masaya Sano1 · Hiroyuki Ito1 · Junko Nagata1 · Hitoshi Ichikawa1 · Seiichirou Kojima1 · Shinji Takashimizu1 · Norihito Watanabe1 Received: 8 June 2020 / Accepted: 17 September 2020 © The Author(s) 2020
Abstract A 23-year-old woman who complained of abdominal distension and anorexia was referred to our hospital. Computed tomography showed ascites, a huge hepatic tumor and ovarian tumor. Gastroscopy revealed type 4 gastric cancer and biopsy examination showed poorly differentiated adenocarcinoma with signet ring cell carcinoma. We diagnosed her with stage IV advanced gastric adenocarcinoma. She received the chemotherapy with S-1 and CDDP regimen. After two courses, this regimen was changed to the SOX (S-1 + OHP) regimen because of acute kidney injury. After one course of the SOX regimen, she developed general muscle cramp. Magnetic resonance imaging showed a 15 mm, round, high-intensity signal at the parietal lobe on T2-weighted images. She was hospitalized for with the suspicion of brain metastasis. Anticonvulsants improved her muscle cramp, but she had consciousness disturbance on the 9th hospital day. T2WI showed high-intensity signals within the cerebral white matter at both sides of the occipital lobe. We suspected leukoencephalopathy caused by S-1 and discontinued the SOX regimen. We also treated her hypertension and hyponatremia. Her consciousness disturbance improved in several days, and the T2WI finding was markedly improved on the 20th hospital day. We diagnosed her with posterior reversible encephalopathy syndrome caused by chemotherapy containing S-1. Keywords PRES · Chemotherapy · S-1
Introduction
Case report
Patients with posterior reversible encephalopathy syndrome (PRES) have several symptoms such as headache, cramp, consciousness disturbance, and visual disturbance due to increasing vascular permeability and vascular endothelial cell disorder caused by intra cerebral hypertension. PRES is caused by several factors including chemotherapy. Meanwhile, S-1 is the key drug for the treatment of advanced gastric cancer. The development of PRES is related to the length of administration and the dose of drugs. However, in the present case, the dose of the drug was not high and the period of administration was not long.
A 23-year-old woman visited a local medical doctor with abdominal distension and anorexia. Computed tomography (CT) showed ascites, a huge hepatic tumor, and an ovarian tumor (Fig. 1a, b). Therefore, she was referred to our hospital. The patient had no history of previous illness and no family history of hereditary diseases. She had no habits of smoking and drinking. On physical examination, she looked pale, her palpebral conjunctivae were anemic, and her abdomen was distended. She had anemia with a hemoglobin level of 4.3 g/dl on blood examination, but the levels of tumor markers, CEA, and CA19-9 were normal. CT sh
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