Soma Jun, Sawada Jun, Uemura Tomohiro, Kikuchi Shiori T, Nakagawa Naoki
Division of Respiratory Medicine and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, JPN.
Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, JPN.
Cureus. 2025 Apr 19;17(4):e82564. doi: 10.7759/cureus.82564. eCollection 2025 Apr.
A 40-year-old Japanese male patient was admitted to the emergency room because he had been experiencing visual disturbances in both eyes for a month, and his fatigue had worsened over the past week. He was diagnosed with IgA nephropathy 24 years ago and underwent a living donor kidney transplant 19 years ago. The patient was administered tacrolimus and mycophenolate mofetil (MMF) since the renal transplantation. Upon admission, his blood pressure (BP) rose to 250/150 mmHg. Neurological examination revealed bilateral light perception, left homonymous hemianopsia, bilateral patellar hyperreflexia, and decreased sensation of vibration below the lumbar region. Brain magnetic resonance imaging (MRI) showed hyperintense areas on both fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) maps in the right parieto-occipital lobe, left basal ganglia, and white matter around the lateral ventricles, brainstem, and bilateral cerebellar hemispheres. Some lesions showed hyperintense areas on the diffusion-weighted image (DWI). MRI of the spinal cord on T2-weighted images showed hyperintense areas in the center of the entire spinal cord. The patient was diagnosed with posterior reversible encephalopathy syndrome with spinal cord involvement (PRES-SCI) and was treated with antihypertensive therapy, immunosuppressive drugs, and dialysis. The patient's clinical symptoms and imaging findings gradually improved. A follow-up MRI of the brain and spinal cord on day 43 after onset showed almost complete disappearance of the lesions. This is the first reported case of PRES-SCI involving the entire spinal cord in a patient with renal disease. In this case, malignant hypertension, post-transplantation rejection, and immunosuppressive medications may have been involved in the onset of PRES-SCI. Prompt diagnosis and treatment may lead to favorable outcomes.
一名40岁的日本男性患者因双眼视力障碍已有一个月，且在过去一周内疲劳加重，被收入急诊室。他24年前被诊断为IgA肾病，19年前接受了活体供肾移植。自肾移植后，患者一直服用他克莫司和霉酚酸酯（MMF）。入院时，他的血压（BP）升至250/150 mmHg。神经系统检查发现双侧光感、左侧同向性偏盲、双侧髌阵挛亢进以及腰部以下振动觉减退。脑部磁共振成像（MRI）显示，在右侧顶枕叶、左侧基底节以及侧脑室周围白质、脑干和双侧小脑半球的液体衰减反转恢复（FLAIR）和表观扩散系数（ADC）图上均有高信号区。一些病变在扩散加权成像（DWI）上也显示为高信号区。脊髓T2加权图像的MRI显示整个脊髓中央有高信号区。该患者被诊断为合并脊髓受累的后部可逆性脑病综合征（PRES-SCI），并接受了降压治疗、免疫抑制药物治疗和透析。患者的临床症状和影像学表现逐渐改善。发病后第43天对脑部和脊髓进行的随访MRI显示病变几乎完全消失。这是首例报道的肾病患者中累及整个脊髓的PRES-SCI病例。在该病例中，恶性高血压、移植后排斥反应和免疫抑制药物可能与PRES-SCI的发病有关。及时诊断和治疗可能会带来良好的预后。
