Posterior Reversible Encephalopathy Syndrome in Systemic Lupus Erythematosus

Abstract

PRES occurs in young lupus patients and in the early part of the disease. Focal deficits are not uncommon. It can be the presenting manifestation of lupus. Management is predominantly symptomatic. Immunosuppression is directed by other major organ manifestations. Early diagnosis and appropriate management is productive.

Systemic Lupus Erythematosus Presenting With Posterior Reversible Encephalopathy Syndrome: An Unusual Case

“…Majority of these patients had lupus nephritis and hypertension [3]. Recent reports have shown a stringent association of PRES with hypertension in SLE patients and response to cyclophosphamide-methylprednisolone pulse therapy [4]. Here, we report a rare case of a normotensive patient of SLE presenting with PRES.…”

Dr. Varaprasad and Dr. Agrawal reply

“…All these are known risk factors for developing PRES. They presented with a symptom complex of seizures, altered sensorium, visual abnormalities, headache, vomiting, and reversible focal deficits 4 . All had characteristic MRI features with bilateral white matter hyperintensities involving not only the classical occipital and parietal lobes but also the frontotemporal and cerebellar areas in 2 cases.…”

Dr. Varaprasad and Dr. Agrawal reply

“…Various factors responsible for PRES in SLE include disease activity (mostly with associated nephritis), renal failure, hypertension, and drugs such as cyclophosphamide and steroids 3 . There are not enough data to understand the exact pathogenesis of PRES but it depends on 2 vital factors, hypertension and endothelial dysfunction, with variable contributions by each 4 .…”