Posterior ReversibleEncephalopathy Syndrome after Paralytic Ileus during B-Cell Precursor Acute Lymphoblastic Leukemia Induction Therapy

A 9 year-old boy with B-cell precursor acute lymphoblastic leukemia developed paralytic ileus and severe abdominal pain during the induction therapy. In spite of fentanyl administration, abdominal pain could not be controlled sufficiently. On 31st day, he had convulsion and second convulsion with sudden severe visual impairment on 33rd day, although his blood pressure was controlled within normal limit. Magnetic resonance imaging revealed hyperintensity lesions in the bilateral frontal and occipital lobes on T2-weighted images and he was diagnosed as having posterior reversible encephalopathy syndrome. His visual activity returned along with an improvement of paralytic ileus and colic pain. In addition to the control of blood pressure, the management of paralytic ileus and pain control are important for the prevention and treatment of posterior reversible encephalopathy syndrome.