Mepolizumab-Induced Posterior Reversible Encephalopathy Syndrome (PRES), a new patient report

Vikram V Puram; Dana Ghazaleh; Apameh Salari; Kaci McCleary; Gerald Moriarty; Kendall Nichols; Malik Ghannam; Kevin Brown; Brent Berry

doi:10.1186/s12883-022-02849-1

Mepolizumab-Induced Posterior Reversible Encephalopathy Syndrome (PRES), a new patient report

BMC Neurol. 2022 Aug 25;22(1):318. doi: 10.1186/s12883-022-02849-1.

Authors

Vikram V Puram¹, Dana Ghazaleh², Apameh Salari³, Kaci McCleary^{3

4}, Gerald Moriarty³, Kendall Nichols³, Malik Ghannam², Kevin Brown^{3

4}, Brent Berry^{5

6

7

8}

Affiliations

¹ University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
² Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
³ Department of Neurology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 55455, USA.
⁴ VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA.
⁵ Department of Neurology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 55455, USA. brentb@umn.edu.
⁶ VA Medical Center, 1 Veterans Drive, Minneapolis, MN, 55417, USA. brentb@umn.edu.
⁷ Dept. of Neurology, Dept. of Sleep Medicine, Dept. of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. brentb@umn.edu.
⁸ BioTechMed Center, Department of Multimedia Systems, Faculty of Electronics, Telecommunication and Informatics, Gdansk University of Technology, 8 Jana Bażyńskiego, 80-309, Gdańsk, Pomeranian Voivodeship, Poland. brentb@umn.edu.

Abstract

Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a neurotoxic state characterized by seizures, headache, vision change, paresis, and altered mental status. PRES has an important place in medicine due to the wide variety of causative diseases, infections, and medications that precipitate its mysterious onset. Although exposure to medications, particularly immunosuppressants, cancer chemotherapy, and biologic drugs, is a common occurrence in patients who develop PRES, Mepolizumab has never before been associated.

Case presentation: This report of a 67-year-old male patient outlines the first reported case of Mepolizumab-induced PRES in the literature.

Conclusions: Treatment of severe asthma, asthma-exacerbations, and diseases such as eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss) with Mepolizumab is rapidly gaining popularity ever since the drug's recent FDA-approval. This report aims to raise awareness of this potentially life-threatening and previously unreported side effect of Mepolizumab since early identification of the causative agent is the key to preventing the severe neurologic disability and possible death that may occur from the delayed treatment of PRES.

Keywords: Asthma; Drug reaction; Mepolizumab; Posterior reversible encephalopathy syndrome.

Publication types

Case Reports

MeSH terms

Aged
Antibodies, Monoclonal, Humanized
Asthma* / complications
Churg-Strauss Syndrome* / chemically induced
Churg-Strauss Syndrome* / diagnosis
Churg-Strauss Syndrome* / drug therapy
Granulomatosis with Polyangiitis* / complications
Humans
Male
Posterior Leukoencephalopathy Syndrome* / chemically induced
Posterior Leukoencephalopathy Syndrome* / diagnostic imaging

Substances

Antibodies, Monoclonal, Humanized
mepolizumab