Posterior Reversible Encephalopathy Syndrome Secondary to Asparaginase
Associated Pancreatitis in Two Pediatric Patients with Acute Leukemia
Abstract
Asparaginase, a critical component of current pediatric acute leukemia
treatment protocols, is associated with a number of serious side
effects, one of which is pancreatitis. Pancreatitis can result in
significant morbidity and mortality from necrosis, pseudocyst formation,
hemorrhage, systemic inflammation, intestinal perforation and sepsis.
Another rare complication of pancreatitis is posterior reversible
encephalopathy syndrome (PRES), likely mediated by systemic inflammation
secondary to pancreatic autodigestion and pro-inflammatory
cytokine-mediated vascular endothelial damage. Here we review this
association in the literature and report two pediatric patients with
leukemia who developed PRES secondary to asparaginase-associated
pancreatitis.