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Candelaresi et al. Vessel Plus 2018;2:11 Vessel Plus
DOI: 10.20517/2574-1209.2018.09

Case Report Open Access

Bortezomib-induced posterior reversible
encephalopathy syndrome: a case report

Paolo Candelaresi , Maria Chiara Casorio 2
1
1 Neurology and Stroke Unit, Department of Emergency Medicine, San Carlo Borromeo Hospital, Milano 20147, Italy.
2 Department of Anaesthesiology and Intensive Care, IRCCS San Matteo, Pavia 27100, Italy.
Correspondence to: Dr. Paolo Candelaresi, Neurology and Stroke Unit, Department of Emergency Medicine, San Carlo Borromeo
Hospital, via Pio II 3, Milano 20147, Italy. E-mail: paolocandelaresi@gmail.com
How to cite this article: Candelaresi P, Casorio MC. Bortezomib-induced posterior reversible encephalopathy syndrome: a case
report. Vessel Plus 2018;2:11. http://dx.doi.org/10.20517/2574-1209.2018.09
Received: 7 Mar 2018 First Decision: 28 Apr 2018 Revised: 29 Apr 2018 Accepted: 11 May 2018 Published: 18 May 2018

Science Editor: Aaron S. Dumont Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological syndrome due to autoregulation
breakthrough with subsequent predominantly vasogenic oedemain associated with several clinical conditions. It is being
increasingly reported in antineoplastic-treated patients. Here we report the case of a 72-year-old man who developed
PRES during the second cycle of bortezomib treatment for multiple myeloma. Unlike usual PRES cases, only moderate
hypertension was present at symptom onset, supporting the hypothesis that alterations of the vascular endothelium
and blood-brain-barrier are the principal pathophysiological mechanisms involved in bortezomib-induced PRES. Prompt
recognition of this potentially serious neurological adverse event is paramount to prevent mortality and long-term
sequelae.

Keywords: Bortezomib, chemotherapy, multiple myeloma, posterior reversible encephalopathy syndrome

INTRODUCTION
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by
variable associations of headache, altered mental status, seizures, visual disturbances and less frequently
other neurological signs. It may develop in association with many clinical conditions, such as acute
hypertension, infections, pre-eclampsia/eclampsia, autoimmune disorders, neoplastic disease, exposure to
[1]
toxins or drugs . Regardless of the underlying cause, cerebral vasogenic edema usually develops due to
impaired autoregulation, blood-brain-barrier damage, and endothelial dysfunction.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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