Perry Ross M, Casey Scott D, Lee Alex Q, Bowditch Sylvia P, Rasmussen Mary A, Sethi Viyeka, Panigrahi Arun R
School of Medicine University of California, Davis, Sacramento, California, USA.
Department of Emergency Medicine University of California, Davis, Sacramento, California, USA.
Case Rep Pediatr. 2024 Jul 30;2024:8829060. doi: 10.1155/2024/8829060. eCollection 2024.
In this article, we describe a novel case of SARS-CoV-2-associated-hemophagocytic lymphohistiocytosis (HLH) complicated by posterior reversible encephalopathy syndrome (PRES). Initially diagnosed with multisystem inflammatory response in children (MIS-C), the patient received a large corticosteroid dose days before the onset of neurological symptoms. After developing PRES, the patient was treated with antihypertensives, antiepileptics, dexamethasone, and anakinra, leading to neurologic normalization. We propose that given the challenging diagnostic picture of PRES developing in patients with HLH or MIS-C, institutionalized standards for blood pressure management during corticosteroid induction may significantly improve outcomes in patients being treated for hyperinflammatory syndromes who develop neurological symptoms.
在本文中，我们描述了1例新型冠状病毒2型相关噬血细胞性淋巴组织细胞增生症（HLH）并发后部可逆性脑病综合征（PRES）的病例。该患者最初被诊断为儿童多系统炎症反应（MIS-C），在出现神经症状前数天接受了大剂量皮质类固醇治疗。出现PRES后，患者接受了抗高血压药、抗癫痫药、地塞米松和阿那白滞素治疗，神经功能恢复正常。我们认为，鉴于HLH或MIS-C患者发生PRES的诊断情况具有挑战性，在皮质类固醇诱导治疗期间制定制度化的血压管理标准可能会显著改善患有神经症状的高炎症综合征患者的治疗结局。
