Reversible Posterior Leukoencephalopathy Syndrome and Bevacizumab

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Abstract
We would like to report the occurrence of reversible posterior leukoencephalopathy that we believe is directly attributable to bevacizumab (Avastin), a recombinant, humanized, monoclonal IgG1 antibody that binds and inhibits vascular endothelial growth factor (VEGF). A 59-year-old woman received seven infusions of bevacizumab at two-week intervals for the treatment of metastatic renal cancer, during which time her blood pressure remained within her usual range, at approximately 100/70 mm Hg. Eight days after the last infusion, she presented to the emergency room with severe lethargy. The physical examination was essentially normal except for a blood pressure of 168/88 mm Hg. Laboratory assessment was remarkable only for a white-cell count of 14,000 per cubic millimeter; urinalysis showed more than 100 white cells per high-power field and a moderate number of bacteria. The cerebrospinal fluid was clear, colorless, and acellular, with a total protein level of 78 mg per deciliter and a glucose level of 66 mg per deciliter. The patient was admitted to the hospital after a tonic–clonic seizure in the emergency room that was treated with lorazepam.