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BMJ Case Rep. 2009;2009. pii: bcr06.2009.1926. doi: 10.1136/bcr.06.2009.1926. Epub 2009 Oct 12.

Reversible posterior leucoencephalopathy syndrome associated with bortezomib in a patient with relapsed multiple myeloma.

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Academic Medical Center/University of Amsterdam, Internal Medicine, F4-222, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands.


Reversible posterior leucoencephalopathy syndrome (RPLS) is a potentially fatal but reversible clinico-radiological syndrome with symptoms of headache, altered mental functioning, visual changes and seizures in association with typical posterior cerebral white matter lesions. RPLS is associated with the use of cytotoxic drugs, usually in combination with high blood pressure. We report a case of RPLS that we believe is associated with bortezomib, a proteasome inhibitor with proapoptotic and antiangiogenic properties approved for the treatment of relapsed multiple myeloma, and speculate about the possible mechanisms leading to RPLS. Clinicians should be aware of the potential association between RPLS and bortezomib because timely recognition and appropriate treatment are important in the prevention of irreversible neurological complications.

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