Kadikoy Huseyin, Haque Waqar, Hoang Vu, Maliakkal Joseph, Nisbet John, Abdellatif Abdul
Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Saudi J Kidney Dis Transpl. 2012 May;23(3):572-6.
Posterior reversible encephalopathy syndrome (PRES) is characterized by acute onset of headache, nausea, focal neurological deficits or seizures along with radiological findings of white matter defects in the parietal and occipital lobes. Causes of PRES include uremia, hypertensive encephalopathy, eclampsia and immunosuppressive medications. Usually, the treatment of choice involves correcting the underlying abnormality. We describe an unusual case of recurrent PRES caused by uremia during a lupus flare in a patient with biopsy-proven Class IV Lupus Nephritis (LN) with vasculitis. PRES in systemic lupus erythematosis (SLE) is a rare clinical phenomenon and, when reported, it is associated with hypertensive encephalopathy. Our patient did not have hypertensive crisis, but had uremic encephalopathy. The patient's PRES-related symptoms resolved after initiation of hemodialysis. The temporal correlation of the correction of the uremia and the resolution of the symptoms of PRES show the etiology to be uremic encephalopathy, making this the first reported case of uremia-induced PRES in Class IV LN with vasculitis.
后部可逆性脑病综合征（PRES）的特征是急性起病的头痛、恶心、局灶性神经功能缺损或癫痫发作，同时伴有顶叶和枕叶白质缺陷的影像学表现。PRES的病因包括尿毒症、高血压脑病、子痫和免疫抑制药物。通常，治疗的首选方法是纠正潜在的异常情况。我们描述了一例不寻常的复发性PRES病例，该病例由一名经活检证实为IV级狼疮性肾炎（LN）伴血管炎的患者在狼疮发作期间的尿毒症引起。系统性红斑狼疮（SLE）中的PRES是一种罕见的临床现象，当有报道时，它与高血压脑病有关。我们的患者没有高血压危象，但有尿毒症性脑病。患者开始血液透析后，与PRES相关的症状得到缓解。尿毒症的纠正与PRES症状的缓解之间的时间相关性表明病因是尿毒症性脑病，这使其成为首例报道的IV级LN伴血管炎中由尿毒症引起的PRES病例。
