Alsultan Mohammad, Basha Kassem
Department of Nephrology, Al Assad and Al Mouwasat University Hospitals, Damascus University- Faculty of Medicine, Damascus, Syria.
Nephrology Department, Al Mouwasat University Hospitals, Damascus University- Faculty of Medicine, Damascus, Syria.
Ann Med Surg (Lond). 2022 May 11;78:103767. doi: 10.1016/j.amsu.2022.103767. eCollection 2022 Jun.
Several conditions of resistant hypertension (RHTN) have been suggested and are often associated in the same patient. Approximately 75% of patients with posterior reversible encephalopathy syndrome (PRES) have moderate to severe HTN at presentation.
A 26- year old SLE-patient presented with seizures followed by confusion and cortical blindness, in the context of emergent HTN and MRI revealed PRES syndrome. However, antihypertensive drugs were increased to maximum doses with two HD sessions, the patient still had high measures of BP. The dilemma was to find the underlying cause of long-term RHTN in this patient, where several etiologies were implicated. We review the status in more specific details and draw a timeline, which showed constant exposer to carbamazepine from the beginning of HTN. Thereafter, converting the patient to levetiracetam resulted in resolving the RHTN.
DISCUSSION/CONCLUSION: We discuss this case with a literature review over the past ten years, which shows only three patients with a neurologic deficit in the context of severe HTN induced by carbamazepine. In the end, determining the secondary etiology of RHTN, in this patient, is considered a diagnosis of challenge due to the coincidence with SLE and the rarity of this side effect of carbamazepine. This is considered a valuable message to always exclude all secondary causes, especially drugs effects, in ESRD-patients with multiple comorbidities.
已经提出了几种难治性高血压（RHTN）的情况，并且这些情况在同一患者中经常同时出现。大约75%的后部可逆性脑病综合征（PRES）患者在发病时患有中度至重度高血压。
一名26岁的系统性红斑狼疮（SLE）患者在突发高血压的情况下出现癫痫发作，随后出现意识模糊和皮质盲，MRI显示为PRES综合征。然而，在进行了两次血液透析治疗并将抗高血压药物增加到最大剂量后，患者的血压仍然很高。难题在于找出该患者长期RHTN的潜在病因，其中涉及多种病因。我们更详细地回顾了病情并绘制了时间线，结果显示从高血压开始就持续接触卡马西平。此后，将患者转换为左乙拉西坦后，难治性高血压得到了解决。
讨论/结论：我们结合过去十年的文献回顾讨论了该病例，结果显示仅有三名患者在卡马西平诱发的严重高血压情况下出现神经功能缺损。最后，由于该患者同时患有SLE且卡马西平这种副作用罕见，确定其RHTN的继发病因被认为是一项具有挑战性的诊断。对于患有多种合并症的终末期肾病（ESRD）患者，始终排除所有继发原因，尤其是药物影响，这被认为是一条有价值的信息。
