Stârcea Magdalena, Gavrilovici Cristina, Munteanu Mihaela, Miron Ingrith
Department of Pediatrics, St. Maria Children's Hospital, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, România.
J Int Med Res. 2018 Mar;46(3):1172-1177. doi: 10.1177/0300060517746559. Epub 2018 Jan 8.
An uncommon side effect of cyclosporine A (CsA) use is posterior reversible encephalopathy syndrome (PRES). PRES usually develops because of disturbed capacity of posterior cerebral blood flow to autoregulate an acute rise in blood pressure. We present the case of a 10-year-old girl who was previously diagnosed in our department with focal segmental glomerulosclerosis. She was treated with CsA and developed seizures, progressive loss of consciousness, and visual disturbance on the 7th day of treatment. Brain magnetic resonance imaging showed degeneration of white matter with diffuse demyelination in the parietal and posterior occipital lobes, consistent with the diagnosis of PRES. Cases of PRES reported in children are usually secondary to immunosuppressive therapy in oncological and haematological diseases. Our case is the fifth reported case of focal segmental glomerulosclerosis in children treated with CsA and complicated by PRES. Rapid recognition of PRES and stopping neurotoxic therapy early are essential for a good prognosis.
环孢素A（CsA）使用的一种罕见副作用是后部可逆性脑病综合征（PRES）。PRES通常是由于大脑后循环血流自动调节血压急性升高的能力受到干扰而发生的。我们报告一例10岁女孩，她之前在我们科室被诊断为局灶节段性肾小球硬化症。她接受CsA治疗，在治疗第7天出现癫痫发作、意识进行性丧失和视觉障碍。脑部磁共振成像显示顶叶和枕叶后部白质变性伴弥漫性脱髓鞘，符合PRES的诊断。儿童中报道的PRES病例通常继发于肿瘤和血液系统疾病的免疫抑制治疗。我们的病例是第五例报道的接受CsA治疗且并发PRES的儿童局灶节段性肾小球硬化症病例。快速识别PRES并尽早停止神经毒性治疗对良好预后至关重要。
