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Takigawa K, Shima T, Kubara C, Akamine S, Utsumi S, Yoshino T, Minami M, Hayashi M, Matsuo Y, Kuriyama T, Yoneda R, Taniguchi S, Eto T. Fatal posterior reversible encephalopathy syndrome after blood transfusion in a patient with myelodysplastic syndromes. Transfusion 2024. [PMID: 39044568 DOI: 10.1111/trf.17968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is known as a transfusion-related complication with typically favorable prognosis and no report fatalities. Pathological evaluation of PRES is also scarce. CASE REPORT An 88-year-old female with myelodysplastic syndromes (MDS) attended our hospital because of a compression fracture and chronic heart failure with chronic anemia. While her hemoglobin levels improved from 4.6 to 8.0 g/dL and the pleural effusions substantially decreased following six units of red blood cell transfusion and diuretic therapy, a gradual decline in cognitive function and speech reduction was noted. PRES was diagnosed by magnetic resonance imaging of the head. Despite treatment of intensive supportive care, the patient fell into a coma by the 20th day and passed away on the 22nd day. Although the pathophysiological link between blood-transfusion-related PRES and its impact on survival is not fully understood, autopsy findings confirmed the diagnosis of PRES and revealed multiple cerebral hemorrhages that were not detected in earlier imaging studies. CONCLUSION This case highlights the importance of vigilant monitoring and management of PRES, especially in high-risk populations such as elderly patients with multiple comorbidities or those with thrombocytopenia. Further studies are needed to elucidate the mechanisms of PRES in patients with hematologic diseases.
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Affiliation(s)
- Ken Takigawa
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Takahiro Shima
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
- Department of Hematology, Kyushu University Hospital, Fukuoka, Japan
| | - Chiaki Kubara
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Shun Akamine
- Department of Pathology, Hamanomachi Hospital, Fukuoka, Japan
| | - Sae Utsumi
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | | | - Mariko Minami
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | | | - Yayoi Matsuo
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Takuro Kuriyama
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Reiko Yoneda
- Department of Pathology, Hamanomachi Hospital, Fukuoka, Japan
| | | | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
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Nakamura H, Adachi S, Uno Y, Mabuchi M, Shimazaki M, Nishiwaki S, Shimizu M. Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e942206. [PMID: 38015823 PMCID: PMC10697558 DOI: 10.12659/ajcr.942206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/25/2023] [Accepted: 10/18/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Group G streptococcus (GGS) infection is reported to have invasive pathogenicity similar to that of group A streptococcus (GAS) infection, causing a strong systemic inflammatory response with bacteremia and various complications. Herein, we report a case of posterior reversible encephalopathy syndrome (PRES) as a rare complication of a GGS infection. CASE REPORT An 89-year-old Japanese man presented to our hospital with gastrointestinal bleeding and shoulder pain. Close examination revealed a refractory duodenal ulcer (DU) with disseminated intravascular coagulation and soft tissue infection of the right arm, which was found to be caused by GGS. A hemorrhagic tendency due to disseminated intravascular coagulation made it difficult to achieve hemostasis, leading to repeated blood transfusions. Although remission of both the DU and infection was achieved with treatment, impairment of swallowing function and vision subsequently appeared. Magnetic resonance imaging revealed hyperintense lesions with elevated apparent diffusion coefficient (ADC) values on T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). The patient was diagnosed with PRES, which did not improve even after discharge on day 118. CONCLUSIONS GGS infection developed with refractory duodenal ulcer bleeding, resulting in PRES with irreversible sequelae. The occurrence of PRES, which may be a rare complication of GGS infection, should be considered when central nervous system manifestations are observed in case of invasive streptococcal infection with a systemic inflammatory response.
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Affiliation(s)
- Hironori Nakamura
- Department of Internal Medicine, Gifu-Seino Medical Center, Ibi Kosei Hospital, Ibigawa, Gifu, Japan
| | - Seiji Adachi
- Department of Internal Medicine, Gifu-Seino Medical Center, Ibi Kosei Hospital, Ibigawa, Gifu, Japan
| | - Yukari Uno
- Department of Internal Medicine, Gifu-Seino Medical Center, Ibi Kosei Hospital, Ibigawa, Gifu, Japan
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, Ibigawa, Gifu, Japan
| | - Masatoshi Mabuchi
- Department of Internal Medicine, Gifu-Seino Medical Center, Ibi Kosei Hospital, Ibigawa, Gifu, Japan
| | - Makoto Shimazaki
- Department of Internal Medicine, Gifu-Seino Medical Center, Ibi Kosei Hospital, Ibigawa, Gifu, Japan
| | - Shinji Nishiwaki
- Department of Internal Medicine, Gifu-Seino Medical Center, Ibi Kosei Hospital, Ibigawa, Gifu, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, Ibigawa, Gifu, Japan
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