Tocilizumab-associated posterior reversible encephalopathy syndrome in giant-cell arteritis \u2013 case report

Michaela Butryn,Oliver Beuing,Eugen Feist,Sabine Mewes,Jens Neumann,Christian Müller

doi:10.1186/s12883-021-02231-7

Abstract

BackroundWe describe one of the first cases of a Posterior reversible encephalopathy syndrome (PRES) under tocilizumab as treatment of Giant cell arteritis (GCA).Case presentationA 65-year-old female with known GCA and treatment with Tocilizumab (TCZ) developed a convulsive epileptic seizure for the first time. MRI was suggestive of PRES and an associated left sided occipital hemorrhage. Extensive high blood pressure values were not detected. The patient recovered within a week and no further seizures occurred under anticonvulsive medication.ConclusionPRES during the treatment with Tocilizumab hasn’t been described in GCA so far. There are single reports of an association between TCZ and PRES in other entities. Thus, a link between interleukin-6 and the integrity of the vasculature could be considered. The clinical consequence should be a stringent blood pressure monitoring in the ambulant setting of patients receiving TCZ.

Highlights

Backround: We describe one of the first cases of a Posterior reversible encephalopathy syndrome (PRES) under tocilizumab as treatment of Giant cell arteritis (GCA)
Tocilizumab (TCZ) is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R), which was first approved for the treatment of rheumatoid arthritis (RA) [2]
In 2009 a patient with RA developed a leukoencephalopathy and more recently a patient with juvenile idiopathic arthritis exhibited PRES in 2018 [7, 8]. Another case described the occurrence of PRES after infusion of anti-B-cell maturation antigen (BCMA) directed Chimeric antigen receptor (CAR) T cells and application of tocilizumab and of high dose methylprednisolone and hydrocortisone to limit the cytokine release syndrome

Summary

Introduction

Backround: We describe one of the first cases of a Posterior reversible encephalopathy syndrome (PRES) under tocilizumab as treatment of Giant cell arteritis (GCA). Tocilizumab (TCZ) is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R), which was first approved for the treatment of rheumatoid arthritis (RA) [2]. * Correspondence: jens.neumann@med.ovgu.de 3Department of Neurology, Otto von Guericke University Magdeburg, Leipziger Straße 44, 39120

Results

Conclusion