AUTHOR=Acerbis Andrea , Orofino Giorgio , Campodonico Edoardo , Del Poggio Anna , Xue Elisabetta , di Matteo Francesca , Spelta Greta , Bruno Alessandro , Falini Andrea , Ciceri Fabio , Peccatori Jacopo , Greco Raffaella TITLE=Pre-engraftment neurological impairment in allogeneic stem cell transplant: A case report of atypical posterior reversible encephalopathy syndrome with pontine involvement JOURNAL=Frontiers in Transplantation VOLUME=1 YEAR=2023 URL=https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2022.1089995 DOI=10.3389/frtra.2022.1089995 ISSN=2813-2440 ABSTRACT=

In the present report, we describe the case of a 59-year-old female who developed pre-engraftment multiple organ failure (MOF) after allogeneic hematopoietic stem cell transplant (HSCT), followed a few days later by a cohort of neurological symptoms leading to a diagnosis of posterior reversible encephalopathy syndrome (PRES). The diagnosis was achieved by excluding more frequent entities associated with neurological symptoms in HSCT and supported by compatible magnetic resonance imaging (MRI) findings, with remarkably interesting less frequent pontine involvement. GvHD prophylaxis, including sirolimus and mycophenolate mofetil (MMF), was discontinued, while carefully controlling blood pressure. In addition, high-dose steroids were employed. After 2 weeks, the neurological symptoms abated, and follow-up MRI showed a complete regression of neurological alterations, confirming the diagnostic hypothesis of PRES.