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Reversible posterior leukoencephalopathy syndrome in an elderly patient: case report A 69-year-old woman developed reversible posterior leukoencephalopathy syndrome (RPLS) during treatment with carboplatin and etoposide for small cell lung cancer [routes and dosages not stated]. The woman was prescribed a chemotherapy regimen comprising carboplatin on day 1 of a 21-day cycle and etoposide on days 1, 2, and 3. On day 8 post-cycle one, she presented to an emergency department with fatigue and nausea. Her condition stabilised over the following 5 days, despite an evolving pancytopenia. However, on day 6 of her admission, she reported mild generalised headache. She was unresponsive 4 hours later. Her Glasgow Coma Scale score was 12/15 and her BP was 142/78mm Hg. Urinary incontinence, lip smacking, and tongue biting were noted. The woman regained consciousness after 20 minutes and reported reduction in visual acuity and a generalised, persistent headache over the following 6 hours. Over the next 18 hours, her visual acuity normalised and her headache resolved with analgesia. An MRI brain scan showed new cortical and subcortical oedema in her occipital lobes and pulvinar of the left thalamus. There were also small areas of gliosis in frontal white matter. A follow-up MRI scan 1 week later revealed complete resolution of occipitoparietal changes. All focal neurology resolved and the woman had no further seizure activity. RPLS was diagnosed based on the clinical and radiological findings. Author comment: "In conclusion, our case highlights an association between carboplatin/etoposide and RPLS." Ryan SA, et al. Reversible posterior leukoencephalopathy induced by carboplatin and etoposide. Medical Oncology 29: 1287-91, No. 2, Jun 2012 803079467 Ireland

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Reactions 10 Nov 2012 No. 1427