Gemcitabine and Cisplatin Induced Reversible Posterior Leukoencephalopathy Syndrome: A Case Report

Background: Reversible Posterior Leukoencephalopathy Syndrome (RPLS) is a rare clinic-radiological condition. The clinical characteristics of this syndrome are headache, seizures, visual disturbances, confusion, and changes in mental status and focal neurological signs. The radiological characteristic of RPLS is bilateral symmetrical reversible vasogenic edema in the grey and white matter of the posterior part of the parietal-occipital lobes, consistent with hyperintensity in magnetic resonance imaging and computer tomography scans of the brain. Herein we report RPLS during the therapy with gemcitabine and cisplatin in a female patient with pancreatic cancer. Case Report: A 66-year-old female patient was admitted to the hospital because of abdominal pain. The results of computer tomography scans of the abdomen showed a 6-cm mass lesion in the tail of the pancreas and multiple metastatic lesions in the liver. A ‘tru-cut’ biopsy of the liver lesion proved to be consistent with adenocarcinoma. A combination chemotherapy regimen consisting of gemcitabine and cisplatin was planned. During this therapy, RPLS developed as a complication. Subsequent administration of chemotherapy was cancelled, and antihypertensive and anti-edema treatments were begun. Following this treatment the patient’s symptoms rapidly improved. There was a dramatic decline in vasogenic edema in control MRI scans which were performed a week later. Conclusion: Failure to diagnose the RPLS and correct the precipitating cause may result in catastrophic permanent brain injury or even death.