Reversible Posterior Leukoencephalopathy Syndrome in a Patient with Relapsed Hodgkin's Disease: A Case Report

Reversible posterior leukoencephalopathy syndrome (RPLS) is a distinctive clinicoradiological entity that's characterized by headache, confusion, seizure and frequent visual disturbances. It is associated with certain neuro-radiological findings, and predominantly white matter abnormalities of the parieto-occipital lobes. RPLS has been identified mostly in patients with malignant hypertension, pre-eclampsia and renal insufficiency and in those patients who are using immunosuppressive agents or cytotoxic drugs. We report here on a case of RPLS in a patient who was undergoing chemotherapy. A 49-year-old woman presented with abrupt mental changes and visual disturbances five days after the administration of a chemotherapeutic agent. MRI showed hyper-intense signals on the magnetic resonance (MR) diffusion images in the bilateral temporal, parietal and occipital lobes. The clinical manifestations completely resolved after one week of treatment that consisted of blood pressure control, a negative intake-output balance and the best supportive care. These radiological changes and the reversible clinical manifestations were consistent with RPLS.

ESHAP Salvage Therapy for Refractory and Relapsed Non-Hodgkins Lymphoma: A Single Center Experience

BACKGROUND: The ESHAP chemotherapy regimen, that is, the combination of the etoposide, methylprednisolone, high-dose cytarabine and cisplatin, has been shown to be active against relapsing or refractory non-Hodgkin's lymphoma (NHL) in previous therapeutic trials. We attempted to determine whether ESHAP therapy would be effective and well-tolerated in Korean patients. METHODS: Twenty two patients with refractory or relapsed NHLs (all aggressive types) were enrolled in this study. We retrospectively evaluated the treatment response, the survival rate and the time to progression. RESULTS: Six patients (27.3%) attained complete remission and eight patients (36.4%) attained partial remission. The overall response rate was 63.6%. The median survival duration was 15.5 months (95% confidence interval; 10.7 to 20.3 months), and the median duration of the time to progression was 8.3 months (95% confidence interval; 0.3 to 16.3 months). Myelosuppression was the major toxicity, but severe neutropenia or thrombocytopenia was rare, and renal toxicity was also infrequent. CONCLUSIONS: ESHAP regimen is effective in Korean patients suffering with relapsed or refractory NHLs, but a more effective salvage modality is needed because of the short duration of remission and the insignificant impact on long-term survival.