Posterior Reversible Encephalopathy Syndrome Following Hyperthermic Intraperitoneal Chemotherapy

A 47-year-old female, diabetic with primary malignant ovarian neoplasm with peritoneal deposits, who underwent neoadjuvant chemotherapy with paclitaxel and carboplatin, was posted for Cytoreductive surgery (CRS) with Hyperthermic intraperitoneal chemotherapy (HIPEC). This approach involves infusing concentrated heated chemotherapeutics into the local tumour-bearing peritoneum, maintaining low serum concentration. Intraoperatively, both the CRS Phase and the HIPEC phase were managed successfully. Postoperatively patient had headache, left thigh numbness, hypertension and one episode of generalised tonic clonic seizure and was diagnosed as Posterior reversible encephalopathy syndrome (PRES). The patient was treated conservatively and shifted out. Hyperthermia, causing systemic inflammation and endothelial ischemic reperfusion injury when combined with cytotoxic effects of chemotherapeutics, puts patients at a higher risk of developing PRES. Thus, chemotherapeutics can rarely induce hypertension and PRES even following HIPEC, where systemic absorption is considered less.