Delayed Gemcitabine-Induced Posterior Reversible Encephalopathy Syndrome

Nephrotic Syndrome and Posterior Reversible Encephalopathy Syndrome as Clinical Presentations of Gemcitabine-Induced Thrombotic Micro-Angiopathy

Gemcitabine-induced thrombotic micro-angiopathy (GiTMA) is a very rare pathology of micro-vascular occlusion with a poor prognosis. In this case report, we present a young male with pancreatic carcinoma who received gemcitabine as adjuvant chemotherapy and developed thrombotic micro-angiopathy (TMA) manifesting as nephrotic syndrome with renal dysfunction and posterior reversible encephalopathy syndrome (PRES). The case was successfully managed with discontinuation of the drug and conservative management. The pathogenesis of GiTMA might be direct endothelial dysfunction with consequent activation of the clotting system. The role of plasma exchanges and monoclonal antibodies is unclear in drug-induced TMA.

Comment on “Posterior reversible encephalopathy syndrome in a patient with metastatic breast cancer: A case report”

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state, manifesting clinical symptoms of headache, altered consciousness, visual disturbances, and seizures. Although several diseases have been identified as causative of PRES, the underlying mechanism remains unclear. Song et al recently published “Posterior reversible encephalopathy syndrome (PRES) in a patient with metastatic breast cancer: A case report“ in the World Journal of Clinical Cases, highlighting and discussing the role of hypercalcemia in PRES as related to uncontrolled hypertension. To build upon this case description, we provide further insight into the possible underlying mechanisms of PRES through this commentary.