Gemcitabine is a commonly used chemotherapeutic agent for a variety of
tumor types. Although this
nucleoside analogue
antineoplastic agent is similar in structure to
cytarabine, central nervous system toxicities have rarely been attributed to
gemcitabine.
Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare but increasingly identifiable clinicoradiologic process in
cancer patients associated with cytotoxic and
immunosuppressive agents. The syndrome is characterized by acute to subacute onset of
headache,
nausea,
vomiting, altered mental status,
seizures, stupor, and visual disturbances. The pathophysiology of RPLS continues to remain controversial but likely involves loss of cerebrovascular autoregulation leading to arteriole leakage. Radiologically, posterior occipital white matter
edema is noted, with characteristic findings on magnetic resonance imaging. Often the syndrome is reversible with treatment of concurrent
hypertension or removal of the causative agent; however, failure to quickly recognize the syndrome and discontinue the offending agent may result in profound and permanent central nervous system dysfunction or death. This article describes a case of RPLS attributed to
gemcitabine use for
pancreatic cancer. Such a descriptive case serves as a platform for the discussion of the syndrome, proposed mechanisms of central nervous system damage, and review of the currently available literature on the topic. With increased awareness of RPLS by oncologists and other medical providers,
cancer patient care may be improved and further insight into this complication of
therapy through continued research may be gained.