A case of uterine sarcoma with pazopanib-induced reversible posterior leukoencephalopathy syndrome

Abstract

Backgrounds: Posterior reversible encephalopathy syndrome (PRES), clinically manifested as convulsions and impaired consciousness, is characterised by oedematous changes centring around the white matter of the occipital lobe and is a reversible condition. Pazopanib (PAZ) was approved for malignant soft tissue tumours in Japan in September 2012. We herein report our experience of a patient who was administered PAZ for uterine sarcoma and developed PRES. Case: A 64-year-old woman was administered PAZ for uterine sarcoma. On the fourth day of treatment, she was taken to the emergency department with a chief complaint of impaired consciousness (GCS: E4V2M5). Right conjugate deviation without new structural disorder was found in CT. A brain MRI performed on disease day 2 revealed a high-intensity region in the white matter of the left occipital lobe in FLAIR images. Vasogenic brain oedema was indicated and considering her clinical symptoms, PRES was suspected. On disease day 8, PRES was diagnosed as the disappearance of abnormal signals as confirmed by a second MRI. The clinical symptoms and imaging findings were improved, and the patient was discharged from the hospital on disease day 9. Discussion: Only a few cases of PAZ-induced PRES have been reported, of which only one has been reported from Japan. While these cases report the development of PRES within 9 days to 2 months after initiation of PAZ, in our patient, it was developed within three days of PAZ treatment. In general, most cases of PRES are considered reversible and have a good prognosis. However, there are some reports of irreversible PES because of delayed treatment and other factors. Based on the above reasons, we believe that we need to take PRES into account and promptly start treatment if characteristic symptoms are observed after the start of PAZ treatment.