Vinblastine-Induced Posterior Reversible Encephalopathy Syndrome in Pediatric Hodgkin Lymphoma

Abstract

AbstractPosterior reversible encephalopathy syndrome (PRES) is a critical care scenario seen with several etiologies. We report a pediatric case of Hodgkin lymphoma presenting with paraneoplastic features of nephrotic syndrome (NS). Diagnosis was confirmed with positron emission tomography-computed tomography scan and immunohistochemistry of the tissue biopsy. Remission for NS was achieved within a week of starting chemotherapy (ABVD–adriamycin, bleomycin, vinblastine, and dacarbazine). After the second cycle, he developed headache, seizures, and hypertension, requiring intensive care management. Magnetic resonance imaging brain was suggestive of PRES. The condition was managed with antihypertensives, antiepileptics, and supportive care. Considering all the risk factors for PRES including the drug, vinblastine, further chemotherapy was administered with only ABD regimen. The child attained complete remission after six cycles of chemotherapy and did not have any further episodes of hypertension or seizures. This case highlights the rare complication of vinblastine in a complicated lymphoid malignancy.