BMJ Case Reports 2009; doi:10.1136/bcr.07.2008.0467
  • Unexpected outcome (positive or negative) including adverse drug reactions

Cyclophosphamide-induced reversible posterior leukoencephalopathy syndrome

  1. Maria Jose Abenza-Abildua1,
  2. Blanca Fuentes1,
  3. Domingo Diaz2,
  4. Aranzazu Royo3,
  5. Teresa Olea4,
  6. Maria Jose Aguilar-Amat1,
  7. Exuperio Diez-Tejedor1
  1. 1
    Hospital Universitario La Paz, Neurology, Paseo de la Castellana 261, Madrid, 28046, Spain
  2. 2
    Hospital Universitario La Paz, Critical Care Unit, Paseo de la Castellana 261, Madrid, 28046, Spain
  3. 3
    Hospital Universitario La Paz, Neuroradiology Section, Paseo de la Castellana 261, Madrid, 28046, Spain
  4. 4
    Hospital Universitario La Paz, Nephrology, Paseo de la Castellana 261, Madrid, Madrid, 28046, Spain
  1. Maria Jose Abenza-Abildua, mariajoaa{at}
  • Published 25 May 2009


Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinical radiological syndrome, characterised by acute headache, altered consciousness, seizures and hypertension. The most frequent causes are hypertensive encephalopathy, eclampsia and some immunosuppressive therapies. The pathogenesis remains unclear, but it appears to be related to altered cerebral circulation, producing oedema that can be seen on MRI, and it resolves in 2 or 3 weeks. In the present report, a possible first reported case of cyclophosphamide-induced RPLS in a 27-year-old man with high blood pressure (HBP) and glomerulonephritis caused by Goodpasture syndrome, treated with cyclophosphamide during the last month and prednisone for glomerulonephritis resulting from Goodpasture syndrome without other immunosuppressive drugs, is described.

Symptoms appeared during a hypertensive crisis, but when cyclophosphamide was replaced by rituximab and hypertension was controlled, the patient did not have neurological symptoms. Almost all reported cases induced by immunosuppressive therapy or other causes were associated with hypertension as well.


  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article