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Cerebral adenovirus endotheliitis presenting as posterior reversible encephalopathy syndrome after allogeneic stem cell transplantation

Bone Marrow Transplantation volume 52, pages 1457–1459 (2017)Cite this article

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Posterior reversible encephalopathy syndrome (PRES) is a rare and generally reversible neurological disorder that was first described in the field of hematopoietic stem cell transplantation (HSCT) by Sloane et al.1 To date, its pathogenesis remains unclear but seems to be related to dysregulation of cerebral blood flow with endothelial dysfunction, resulting in cerebral hypoperfusion and a brain capillary leak syndrome. This syndrome is characterized by headaches, visual disturbances, seizures and an altered state of consciousness.2 It is mostly associated with radiological hypodensities in the posterior white matter, most frequently in the parietal and occipital lobes.3 PRES can mimic many other neurological conditions such as autoimmune encephalopathy, central nervous system vasculitis, ischemic stroke, toxi-metabolic encephalopathy and demyelinating disorders. Because there are currently no specific diagnostic criteria, clinical findings and neuroimaging are essential to diagnose PRES promptly and initiate the appropriate treatment.

We report an unusual case of a multiple myeloma patient who presented with clinical manifestations compatible with PRES, 7 months after allogeneic HSCT while taking tacrolimus for treatment of grade III acute GvHD and bortezomib to prevent myeloma relapse. On autopsy, the patient was found to have disseminated adenovirus vascular endothelial infection.

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Acknowledgements

This work was supported by the Université de Montréal Maryse and William Brock Chair in Applied Research into Stem Cell Transplantation and by Myeloma Canada Chair.

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Authors and Affiliations

  1. Division of Hematology, Oncology and Transplantation. Maisonneuve-Rosemont Hospital and Université de Montréal, Montréal, Quebec, Canada

    J-S Claveau, R LeBlanc, I Ahmad, N Bambace, L Bernard, S Cohen, J-S Delisle, T Kiss, S Lachance & J Roy

  2. Division of Pathology, Maisonneuve-Rosemont Hospital and Université de Montréal, Montréal, Quebec, Canada

    J Ferreira

  3. Department of Radiology, Maisonneuve-Rosemont Hospital and Université de Montréal, Montréal, Quebec, Canada

    A-A Pistono

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  1. J-S Claveau
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Correspondence to J Roy.

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Claveau, JS., LeBlanc, R., Ahmad, I. et al. Cerebral adenovirus endotheliitis presenting as posterior reversible encephalopathy syndrome after allogeneic stem cell transplantation. Bone Marrow Transplant 52, 1457–1459 (2017). https://doi.org/10.1038/bmt.2017.154

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