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      Daptomycin-Induced Posterior Reversible Encephalopathy Syndrome (PRES)

      case-report
      Author(s): ,
      Publication date (Electronic):
      Journal: Case Reports in Neurological Medicine
      Publisher: Hindawi

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          Abstract

          Aims

          To present a 60-year-old female patient who manifested clinical and radiological features of posterior reversible encephalopathy syndrome (PRES) following the administration of Daptomycin for glycopeptide-resistant Enterococcal urinary tract infection.

          Material

          Case report.

          Method

          Posterior reversible encephalopathy syndrome was diagnosed in our patient following the administration of Daptomycin based on clinical suspicion as well as brain CT and MRI imaging.

          Results

          The temporal association between the initiation of Daptomycin and the onset of PRES is highly suggestive of causality, and this is further supported by clinical and radiological resolution after Daptomycin was withdrawn.

          Conclusion

          This is the first report of Daptomycin-induced posterior reversible encephalopathy syndrome.

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          Most cited references15

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          Posterior reversible encephalopathy syndrome in infection, sepsis, and shock.

          W Bartynski, J Boardman, Z Zeigler … (2015)
          The cause of "posterior reversible encephalopathy syndrome" (PRES) is not established. We recently encountered several patients who developed PRES in the setting of severe infection. In this study, we comprehensively reviewed the clinical and imaging features in a large cohort of patients who developed PRES, with particular attention to those with isolated infection, sepsis, or shock (I/S/S). The clinical/imaging features of 106 patients who developed PRES were comprehensively evaluated. In 25 of these patients, PRES occurred in association with severe I/S/S separate from transplantation. The clinical/imaging features (computer tomography, MR imaging, and MR angiography [MRA]) of the patients with I/S/S were further evaluated, including organ/tissue/blood culture results, mean arterial blood pressure (MAP) at toxicity, extent of cerebral edema, and presence of vasospasm. PRES occurred in association with I/S/S in 25 of 106 patients (23.6%), in addition to 4 other major clinical settings, including cyclosporine/FK-506 (post-transplant) neurotoxicity (46.2%), autoimmune disease (10.4%), postchemotherapy (3.7%), and eclampsia (10.4%). In the 25 patients with I/S/S, available cultures demonstrated a predominance of gram-positive organisms (84%). Blood pressure was "normal" at toxicity in 10 patients (MAP, 95 mm Hg); "severe" hypertension was present in 15 patients (MAP, 137 mm Hg). Extent of brain edema graded on imaging studies was greater in the normal MAP group compared with the severe hypertension group (P < .05). MRA demonstrated vasospasm in patients with severe hypertension and vessel "pruning" in the normal MAP group. Infection/sepsis/shock may be an important cause of PRES, particularly in relation to infection with gram-positive organisms.
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            The posterior reversible encephalopathy syndrome: what's certain, what's new?

            Justin C. Roth, A Ferbert (2011)
            The posterior reversible encephalopathy syndrome is an increasingly recognised disorder. Most patients have several symptoms; seizures are the most frequent, often multiple or status epilepticus. A combination of seizures, visual disturbance and/or headache, in particular, should lead to an early brain MRI to reveal the typical pattern of bilateral hyperintensities on fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. There seem to be many possible triggers, including abrupt arterial hypertension, impaired renal function, pregnancy, immunosuppressive therapies and various inflammatory conditions. The clinical outcome is excellent, with recovery within a few days, while the MRI abnormalities resolve much more slowly. Little is known about the best management. Seizures do not normally progress to chronic epilepsy so antiepileptic drugs should be discontinued after about 3 months.
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              Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases.

              Allison R. Schwartz, J Antin, R Klufas … (1995)
              The neurotoxic effects of cyclosporine therapy are well known but poorly understood. Imaging studies typically show subcortical edema predominantly affecting the posterior regions of the brain. We sought to determine the causes for these findings by comparing radiographic data with various clinical parameters. In a 3-year period, 16 patients with neurologic findings attributed to cyclosporine therapy were examined with CT, MR imaging, or both. In most cases, imaging was performed both at the onset of the neurologic syndrome and after it had resolved. The radiographic findings were evaluated with respect to lesion location and changes over time. Various clinical and laboratory data obtained throughout the patients' hospital course were also reviewed, including cyclosporine levels, blood pressure values, hematologic data, and serum levels of cholesterol, magnesium, creatinine, and albumin. The only major factor associated with the neurotoxic effects of cyclosporine in all patients was systemic hypertension. Microangiopathic hemolytic anemia, thrombocytopenia, and hypoalbuminemia were also common, and patients usually displayed signs of sympathetic overactivation. The onset of neurologic symptoms was unrelated to serum levels of creatinine, magnesium, cholesterol, or cyclosporine. The clinical and radiographic findings of these patients were identical to those previously reported in patients with hypertensive encephalopathy. Findings resolved in all but one patient after reduction of blood pressure, with or without reduction in cyclosporine dose. In four patients, intracranial hemorrhages occurred during the hypertensive episode, resulting in one fatality. The clinical and radiologic findings in patients showing the neurotoxic effects of cyclosporine appear to be identical to those with hypertensive encephalopathy. Other associated factors, such as cyclosporine-induced vasculopathy or hypoalbuminemia may also play a role in the condition, and intracranial hemorrhage may occur owing to associated thrombocytopenia. Symptoms generally resolve after reduction of blood pressure, and follow-up is usually unnecessary in uncomplicated cases.
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                Author and article information

                Contributors
                C. Soper:
                ORCID: http://orcid.org/0000-0003-1388-1874
                Journal
                Journal ID (nlm-ta): Case Rep Neurol Med
                Journal ID (iso-abbrev): Case Rep Neurol Med
                Journal ID (publisher-id): CRINM
                Title: Case Reports in Neurological Medicine
                Publisher: Hindawi
                ISSN (Print): 2090-6668
                ISSN (Electronic): 2090-6676
                Publication date Collection: 2019
                Publication date (Electronic): 24 February 2019
                Volume: 2019
                Electronic Location Identifier: 8756932
                Affiliations
                Croydon University Hospital, 530 London Road, Croydon CR7 7YE, UK
                Author notes

                Academic Editor: Chin-Chang Huang

                Author information
                http://orcid.org/0000-0003-1388-1874
                Article
                DOI: 10.1155/2019/8756932
                PMC ID: 6408990
                SO-VID: 793fbef2-2fd5-4448-996e-04d59a999c7d
                Copyright © Copyright © 2019 A. Bitar De Zayas-Enriquez and C. Soper.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 September 2018
                Date revision received : 4 January 2019
                Date accepted : 5 February 2019
                Categories
                Subject: Case Report

                Data availability:

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