Song CH, Lee SJ, Jeon HR. Posterior reversible encephalopathy syndrome in a patient with metastatic breast cancer: A case report. World J Clin Cases 2022; 10(7): 2281-2285 [PMID: 35321170 DOI: 10.12998/wjcc.v10.i7.2281]
Corresponding Author of This Article
Ha Ra Jeon, MD, Doctor, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, 100 ilsan-ro, ilsan-donggu, Goyang-si Gyeonggi-do ASI/KR/KS009/Goyang, 10444 Korea, South Korea. jeon1021@nhimc.or.kr
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 6, 2022; 10(7): 2281-2285 Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2281
Posterior reversible encephalopathy syndrome in a patient with metastatic breast cancer: A case report
Chae Hyun Song, Seung Jun Lee, Ha Ra Jeon
Chae Hyun Song, Seung Jun Lee, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang-si Gyeonggi-do 10444, South Korea
Ha Ra Jeon, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang-si Gyeonggi-do ASI/KR/KS009/Goyang, South Korea
Author contributions: Jeon HR, and Song CH designed the research study; Jeon HR, Song CH, and Lee SJ wrote the manuscript; all authors have read and approve the final manuscript.
Informed consent statement: This report is a retrospective study based on medical records, and written consent was obtained from the Ethics Committee.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016)
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ha Ra Jeon, MD, Doctor, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, 100 ilsan-ro, ilsan-donggu, Goyang-si Gyeonggi-do ASI/KR/KS009/Goyang, 10444 Korea, South Korea. jeon1021@nhimc.or.kr
Received: July 28, 2021 Peer-review started: July 28, 2021 First decision: October 25, 2021 Revised: November 5, 2021 Accepted: January 25, 2022 Article in press: January 25, 2022 Published online: March 6, 2022 Processing time: 217 Days and 3.1 Hours
Abstract
BACKGROUND
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state with clinical symptoms such as headache, altered consciousness, visual disturbances, and seizures. Vasogenic edema occurs predominantly in the posterior occipital and parietal lobes of the brain. PRES is caused by various diseases, and its mechanism remains unclear. However, it can be easily diagnosed based on characteristic lesions on magnetic resonance imaging.
CASE SUMMARY
A 51-year-old woman with unremarkable past medical history presented with progressively worsening back pain since 2 mo. Physical examinations revealed paralumbar muscle tenderness, a large lesion on the right breast and several mass-like lesions on both breasts. The blood pressure (BP) was elevated (150/90 mmHg), and did not respond to antihypertensive medication. On the seventh day of hospitalization, she exhibited a confused mental status and generalized tonic-clonic seizures. On magnetic resonance imaging, bilateral cortical and subcortical edema of the occipital lobes, suggestive of PRES, was observed. The serum calcium was 15.8 mg/dL. After two days of treatment with nicardipine, elcatonin, and zolendronic acid, her BP was 130/91 mmHg and serum calcium was 10.1 mg/dL. The patient regained consciousness and her mental status improved. Fluorodeoxyglucose-positron emission tomography revealed right breast cancer with extensive metastases.
CONCLUSION
Although rare, hypercalcemia can lead to PRES by causing uncontrolled hypertension. Prompt diagnosis can help prevent severe mental disturbances and even death.
Core Tip: Posterior reversible encephalopathy syndrome (PRES) is a treatable but potentially fatal encephalopathic state that can accompany various conditions. Although hypercalcemia-related PRES is rare, it may occur in certain diseases. In this case report, metastatic breast cancer led to hypercalcemia, which led to uncontrolled hypertension and finally, PRES.
