PRES-like leukoencephalopathy presenting with status epilepticus associated with Brentuximab Vedotin treatment

PRES-like leukoencephalopathy presenting with status epilepticus associated with Brentuximab Vedotin treatment

Authors

  • Alessandro Orsini Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
  • Sayla Bernasconi Pediatric Neurology Unit, Dinogmi, Giannina Gaslini’s Istitute, University of Genoa, Italy
  • Maria Cristina Bianchi Neuroradiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
  • Ilaria Trivelli Neuroradiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
  • Maria Cristina Menconi Pediatric Oncohematology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
  • Margherita Nardi Pediatric Oncohematology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
  • Andrea Santangelo Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
  • Gabriella Casazza Pediatric Oncohematology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
  • Niccolò Carli Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa
  • Maria Grazia Esposito Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
  • Diego Peroni Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
  • Pasquale Striano Pediatric Neurology Unit, Dinogmi, Giannina Gaslini’s Istitute, University of Genoa, Italy
  • Thomas Foiadelli Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia
  • Alice Bonuccelli Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy

Keywords:

Atypical PRES, Brentuximab-Vedotin, Status Epilepticus, leukoencephalopathy

Abstract

Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by acute neurological symptoms with typical imaging features, primarily in the territories of the brain supplied by the posterior circulation, probably due to vasogenic edema. Both clinical and imaging features are generally reversible. We report a 13-year-old girl affected by Nodular Sclerosis Classical Hodgkin Lymphoma stage IIIB into complete remission, with a recurrence and autologous bone-marrow transplantation, who has been treated with an anti-CD30 monoclonal antibody, brentuximab-vedotin.

The girl has suddenly presented a convulsive status epilepticus, that needed intubation and sedation. Therefore, an IV therapy with levetiracetam was started. Furthermore, the girl has presented high blood pressure and reduced kidney function. Brain MRI demonstrated a diffuse PRES-like disease, that went into regression after the first week. After another week, the girl presented a new prolonged generalized tonic clonic convulsive episode, that needed intubation and sedation and an association of clobazam and levetiracetam: a new brain MRI showed a recurrence of PRES-like lesions in addition to some signs of leukoencephalopathy with brain lactate accumulation on 1H-MRS, due to cerebral energetic failure. The girl also presented a refractory arterial hypertension. After 45 days of ICU hospitalization the patient has been discharged and followed up with neurological examinations. Brain MRI and brain 1H-MRS, 5 months after patient’s discharge, showed incomplete regression of cerebral white matter signal abnormalities with MRS normalization.

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Published

21-03-2022

How to Cite

1.
PRES-like leukoencephalopathy presenting with status epilepticus associated with Brentuximab Vedotin treatment. Acta Biomed [Internet]. 2022 Mar. 21 [cited 2024 Jun. 24];92(S4):e2021416. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/12665