Lupus Nephritis with Posterior Reversible Encephalopathy Syndrome as the First Manifestation of Systemic Lupus Erythematosus

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) is an acute neurological disorder characterized by a variety of neurologic symptoms. The common trigger of PRES is kidney disease, as lupus nephritis. We describe a case of lupus nephritis with PRES.

Case Report: A 20-year-old female was admitted to the hospital for lower extremity edema and malar rash. Her laboratory tests showed anemia, mild elevated creatinine and nephrotic syndrome. Anti-ANA and dsDNA were both positive C3 and C4 complement factors were low. Ultrasounds demostrated normal kidneys. A renal biopsy showed stage IV lupus nephritis and treatment with Hydroxychloroquine, glucocorticoids and Mycophenolate was staarted. During hospitalization she referred headache with visual disturbances and she was found to have a hight blood pressure. After initial stabilization with antihypertensives, a magnetic resonance imaging (MRI) showed patchy cortical and subcortical edema in fontoparietal and occipital regions suggestive of PRES. She was treated with antihypertensives and osmotic agents (mannitol). She was monitored and was subsequently disharged showed complete renal remission and no obvious abnormaly of brain MRI.