Which medication is the most common medication associated with Reversible Posterior Leukoencephalopathy syndrome (RPLS)?

• A. Cyclosporine
• B. Tacrolimus
• C. Mycophenolate
• D. Azathioprine

Answer: (A)

RPLS, now more commonly called PRES, is most often triggered by calcineurin inhibitors used as immunosuppressants because these drugs damage the endothelium and disrupt the brain’s ability to regulate blood flow, leading to edema in the posterior white matter. Cyclosporine is the classic, most frequently reported culprit among these medications. Tacrolimus can also cause PRES, but it’s encountered less often in practice. Mycophenolate and azathioprine are not typical triggers for PRES. When PRES is suspected, management centers on stopping or altering the offending drug, controlling blood pressure if elevated, and providing supportive care to reduce edema and prevent seizures.