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

Alessandro  Orsini; Sayla  Bernasconi; Maria Cristina  Bianchi; Ilaria  Trivelli; Maria Cristina  Menconi; Margherita  Nardi; Andrea  Santangelo; Gabriella  Casazza; Niccolò  Carli; Maria Grazia  Esposito; Diego Peroni; Pasquale Striano; Thomas Foiadelli; Alice Bonuccelli

doi:10.23750/abm.v92iS4.12665

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

DOI: https://doi.org/10.23750/abm.v92iS4.12665

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.

References

Musioł K, Waz S, Boroń M, Kwiatek M, Machnikowska-Sokołowska M, Gruszczyńska K, et al. PRES in the course of hemato-oncological treatment in children. Childs Nerv Syst. 2018;34(4):691-9.

Cordelli DM, Marra C, Ciampoli L, Barbon D, Toni F, Zama D, et al. Posterior Reversible Encephalopathy Syndrome in infants and young children. Eur J Paediatr Neurol. 2021;30:128-33.

Kozak OS, Wijdicks EF, Manno EM, Miley JT, Rabinstein AA. Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology. 2007;69(9):894-7.

Nasri A, Bedoui I, Mrissa R, Riahi A, Derbali H, Zaouali J, et al. Recurrent status epilepticus in posterior reversible encephalopathy syndrome as initial feature of pediatric lupus: A newly diagnosed case and literature review. Brain Dev. 2016;38(9):835-41.

Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-23.

Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 2008;29(6):1043-9.

Masetti R, Cordelli DM, Zama D, Vendemini F, Biagi C, Franzoni E, et al. PRES in Children Undergoing Hematopoietic Stem Cell or Solid Organ Transplantation. Pediatrics. 2015;135(5):890-901.

Orsini A, Foiadelli T, Costagliola G, Michev A, Consolini R, Vinci F, et al. The role of inflammatory mediators in epilepsy: Focus on developmental and epileptic encephalopathies and therapeutic implications. Epilepsy Res. 2021;172:106588.

Bellantoni G, Guerrini F, Del Maestro M, Galzio R, Luzzi S. Simple schwannomatosis or an incomplete Coffin-Siris? Report of a particular case. eNeurologicalSci. 2019;14:31-3.

Ciappetta P, D'Urso P I, Luzzi S, Ingravallo G, Cimmino A, Resta L. Cystic dilation of the ventriculus terminalis in adults. J Neurosurg Spine. 2008;8(1):92-9.

Savioli G, Ceresa IF, Macedonio S, Gerosa S, Belliato M, Iotti GA, et al. Trauma Coagulopathy and Its Outcomes. Medicina (Kaunas). 2020;56(4).

Giotta Lucifero A, Baldoncini M, Bruno N, Galzio R, Hernesniemi J, Luzzi S. Shedding the Light on the Natural History of Intracranial Aneurysms: An Updated Overview. Medicina (Kaunas). 2021;57(8).

Luzzi S, Gragnaniello C, Giotta Lucifero A, Del Maestro M, Galzio R. Surgical Management of Giant Intracranial Aneurysms: Overall Results of a Large Series. World Neurosurg. 2020;144:e119-e37.

Luzzi S, Gragnaniello C, Giotta Lucifero A, Del Maestro M, Galzio R. Microneurosurgical management of giant intracranial aneurysms: Datasets of a twenty-year experience. Data Brief. 2020;33:106537.

Berzero G, Campanini G, Vegezzi E, Paoletti M, Pichiecchio A, Simoncelli AM, et al. Human Herpesvirus 6 Encephalitis in Immunocompetent and Immunocompromised Hosts. Neurol Neuroimmunol Neuroinflamm. 2021;8(2).

Garone G, Reale A, Vanacore N, Parisi P, Bondone C, Suppiej A, et al. Acute ataxia in paediatric emergency departments: a multicentre Italian study. Arch Dis Child. 2019;104(8):768-74.

Foiadelli T, Piccorossi A, Sacchi L, De Amici M, Tucci M, Brambilla I, et al. Clinical characteristics of headache in Italian adolescents aged 11-16 years: a cross-sectional questionnaire school-based study. Ital J Pediatr. 2018;44(1):44.

Luzzi S, Gragnaniello C, Giotta Lucifero A, Marasco S, Elsawaf Y, Del Maestro M, et al. Anterolateral approach for subaxial vertebral artery decompression in the treatment of rotational occlusion syndrome: results of a personal series and technical note. Neurol Res. 2021;43(2):110-25.

Luzzi S, Gragnaniello C, Marasco S, Lucifero AG, Del Maestro M, Bellantoni G, et al. Subaxial Vertebral Artery Rotational Occlusion Syndrome: An Overview of Clinical Aspects, Diagnostic Work-Up, and Surgical Management. Asian Spine J. 2020.

Luzzi S, Del Maestro M, Elbabaa SK, Galzio R. Letter to the Editor Regarding "One and Done: Multimodal Treatment of Pediatric Cerebral Arteriovenous Malformations in a Single Anesthesia Event". World Neurosurg. 2020;134:660.

Feske SK. Posterior reversible encephalopathy syndrome: a review. Semin Neurol. 2011;31(2):202-15.

McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189(4):904-12.

Kastrup O, Schlamann M, Moenninghoff C, Forsting M, Goericke S. Posterior Reversible Encephalopathy Syndrome: The Spectrum of MR Imaging Patterns. Clin Neuroradiol. 2015;25(2):161-71.

von Geldern G, Pardo CA, Calabresi PA, Newsome SD. PML-IRIS in a patient treated with brentuximab. Neurology. 2012;79(20):2075-7.

Carson KR, Newsome SD, Kim EJ, Wagner-Johnston ND, von Geldern G, Moskowitz CH, et al. Progressive multifocal leukoencephalopathy associated with brentuximab vedotin therapy: a report of 5 cases from the Southern Network on Adverse Reactions (SONAR) project. Cancer. 2014;120(16):2464-71.

Giotta Lucifero A, Luzzi S. Against the Resilience of High-Grade Gliomas: The Immunotherapeutic Approach (Part I). Brain Sci. 2021;11(3).

Giotta Lucifero A, Luzzi S, Brambilla I, Schena L, Mosconi M, Foiadelli T, et al. Potential roads for reaching the summit: an overview on target therapies for high-grade gliomas. Acta Biomed. 2020;91(7-s):61-78.

Luzzi S, Giotta Lucifero A, Brambilla I, Semeria Mantelli S, Mosconi M, Foiadelli T, et al. Targeting the medulloblastoma: a molecular-based approach. Acta Biomed. 2020;91(7-s):79-100.

Giotta Lucifero A, Luzzi S, Brambilla I, Trabatti C, Mosconi M, Savasta S, et al. Innovative therapies for malignant brain tumors: the road to a tailored cure. Acta Biomed. 2020;91(7-s):5-17.

Luzzi S, Crovace AM, Del Maestro M, Giotta Lucifero A, Elbabaa SK, Cinque B, et al. The cell-based approach in neurosurgery: ongoing trends and future perspectives. Heliyon. 2019;5(11):e02818.

Sharma P, Abbas MK, Huynh M. Posterior Reversible Encephalopathy Syndrome (PRES) Presenting as Status Epilepticus: A Case Report and Literature Review. Conn Med. 2016;80(8):475-8.