Rituximab (monoclonal anti-CD20 antibody) induced posterior reversible encephalopathy syndrome (PRES): A case report and literature review
Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological condition characterized by reversible subcortical vasogenic edema that primarily affects the posterior areas of the brain. Subcortical vasogenic edema resulting from endothelial injury and hypertension is the pathogenesi...
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Elsevier
2025-03-01
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| author | Praveen K. Sharma, MD Sanjaykanth Balachandar, MBBS Michael Antony Vikram, MBBS Pujitha Duvooru Sukumar, MD |
| author_facet | Praveen K. Sharma, MD Sanjaykanth Balachandar, MBBS Michael Antony Vikram, MBBS Pujitha Duvooru Sukumar, MD |
| author_sort | Praveen K. Sharma, MD |
| collection | DOAJ |
| description | Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological condition characterized by reversible subcortical vasogenic edema that primarily affects the posterior areas of the brain. Subcortical vasogenic edema resulting from endothelial injury and hypertension is the pathogenesis. Here, we present a 23-year-old female patient with systemic lupus erythematosus (SLE) and lupus nephritis who developed PRES following Rituximab (a monoclonal anti-CD-20 antibody) administration. The patient initially presented with severe headaches, visual disturbances, and an altered mental status. Neurological examination revealed bilateral cortical blindness, hyperreflexia, and seizures. Brain imaging, including MRI, demonstrated characteristic findings of PRES, with symmetric hyperintensities involving the occipital and parietal lobes on T2-weighted and FLAIR sequences, consistent with vasogenic edema. Rituximab is promptly discontinued, and the patient was managed with supportive care, including antiepileptic drugs and blood pressure control. Within days of Rituximab cessation, the patient showed gradual improvement in symptoms, with resolution of cortical blindness and normalization of MRI findings. Follow-up assessments revealed complete neurological recovery without residual deficits. This instance emphasizes how crucial it is to take into account PRES as a possible side effect in patients receiving Rituximab therapy, especially if those individuals have sudden neurological symptoms. The offending agent must be located and eliminated immediately for the best outcomes. Clinicians should maintain a high index of suspicion for PRES in patients receiving monoclonal anti-CD20 antibody therapies, immunosuppressants, and corticosteroids, facilitating timely diagnosis and intervention to prevent potentially life-threatening complications. More studies are necessary to clarify the pathophysiological mechanisms causing the PRES produced by Rituximab and to improve therapeutic approaches. |
| format | Article |
| id | doaj-art-077b2124477640f08038af413d4817bc |
| institution | Kabale University |
| issn | 1930-0433 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj-art-077b2124477640f08038af413d4817bc2025-01-18T05:03:58ZengElsevierRadiology Case Reports1930-04332025-03-0120315381547Rituximab (monoclonal anti-CD20 antibody) induced posterior reversible encephalopathy syndrome (PRES): A case report and literature reviewPraveen K. Sharma, MD0Sanjaykanth Balachandar, MBBS1Michael Antony Vikram, MBBS2Pujitha Duvooru Sukumar, MD3Department of Radio-Diagnosis, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105, IndiaDepartment of Radio-Diagnosis, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105, IndiaCorresponding author.; Department of Radio-Diagnosis, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105, IndiaDepartment of Radio-Diagnosis, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105, IndiaPosterior reversible encephalopathy syndrome (PRES) is an uncommon neurological condition characterized by reversible subcortical vasogenic edema that primarily affects the posterior areas of the brain. Subcortical vasogenic edema resulting from endothelial injury and hypertension is the pathogenesis. Here, we present a 23-year-old female patient with systemic lupus erythematosus (SLE) and lupus nephritis who developed PRES following Rituximab (a monoclonal anti-CD-20 antibody) administration. The patient initially presented with severe headaches, visual disturbances, and an altered mental status. Neurological examination revealed bilateral cortical blindness, hyperreflexia, and seizures. Brain imaging, including MRI, demonstrated characteristic findings of PRES, with symmetric hyperintensities involving the occipital and parietal lobes on T2-weighted and FLAIR sequences, consistent with vasogenic edema. Rituximab is promptly discontinued, and the patient was managed with supportive care, including antiepileptic drugs and blood pressure control. Within days of Rituximab cessation, the patient showed gradual improvement in symptoms, with resolution of cortical blindness and normalization of MRI findings. Follow-up assessments revealed complete neurological recovery without residual deficits. This instance emphasizes how crucial it is to take into account PRES as a possible side effect in patients receiving Rituximab therapy, especially if those individuals have sudden neurological symptoms. The offending agent must be located and eliminated immediately for the best outcomes. Clinicians should maintain a high index of suspicion for PRES in patients receiving monoclonal anti-CD20 antibody therapies, immunosuppressants, and corticosteroids, facilitating timely diagnosis and intervention to prevent potentially life-threatening complications. More studies are necessary to clarify the pathophysiological mechanisms causing the PRES produced by Rituximab and to improve therapeutic approaches.http://www.sciencedirect.com/science/article/pii/S1930043324013372Posterior leukoencephalopathy syndromeRituximabHypertensionSeizuresAnticonvulsantsMagnetic resonance imaging |
| spellingShingle | Praveen K. Sharma, MD Sanjaykanth Balachandar, MBBS Michael Antony Vikram, MBBS Pujitha Duvooru Sukumar, MD Rituximab (monoclonal anti-CD20 antibody) induced posterior reversible encephalopathy syndrome (PRES): A case report and literature review Radiology Case Reports Posterior leukoencephalopathy syndrome Rituximab Hypertension Seizures Anticonvulsants Magnetic resonance imaging |
| title | Rituximab (monoclonal anti-CD20 antibody) induced posterior reversible encephalopathy syndrome (PRES): A case report and literature review |
| title_full | Rituximab (monoclonal anti-CD20 antibody) induced posterior reversible encephalopathy syndrome (PRES): A case report and literature review |
| title_fullStr | Rituximab (monoclonal anti-CD20 antibody) induced posterior reversible encephalopathy syndrome (PRES): A case report and literature review |
| title_full_unstemmed | Rituximab (monoclonal anti-CD20 antibody) induced posterior reversible encephalopathy syndrome (PRES): A case report and literature review |
| title_short | Rituximab (monoclonal anti-CD20 antibody) induced posterior reversible encephalopathy syndrome (PRES): A case report and literature review |
| title_sort | rituximab monoclonal anti cd20 antibody induced posterior reversible encephalopathy syndrome pres a case report and literature review |
| topic | Posterior leukoencephalopathy syndrome Rituximab Hypertension Seizures Anticonvulsants Magnetic resonance imaging |
| url | http://www.sciencedirect.com/science/article/pii/S1930043324013372 |
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