The posterior reversible encephalopathy syndrome in HIV infection

Abstract

Posterior reversible encephalopathy syndrome (PRES) is often associated with hypertension, however recent advances in the understanding of this condition have shown that endothelial dysfunction is responsible for much of the pathogenesis and the condition can occur in the absence of hypertension. This case describes a 32-year-old lady with untreated HIV infection who developed PRES at a normal blood pressure and without opportunistic infection or other conditions known to precipitate PRES. HIV, particularly when untreated, is associated with endothelial dysfunction and this may have been sufficient to cause PRES in this patient. To our knowledge this is the first case to describe PRES in HIV without uncontrolled hypertension, sepsis or other precipitating cause.

An atypical subacute presentation of posterior reversible encephalopathy syndrome

“…Acute severe hypertension is the most classic precipitant of PRES [2]. Other well-documented causes include HIV infection, renal failure, pre-eclampsia, injection drug use, sepsis, electrolyte imbalance, organ transplantation, autoimmune diseases and immunosuppressive drugs [2,4,7–11]. Possible causes in our patient include severe variation in BP, HIV/AIDS, ESRD, and cocaine use.…”

“…HIV infection has been implicated as the etiological factor in many published cases of PRES [8,9,11,13]. HIV virus has been shown to induce endothelial cell apoptosis, tight junction disruption, oxidative stress, and the expression of pro-inflammatory cytokines and adhesion molecules which stimulate endothelial cell inflammation, all of which culminates in BBB dysfunction [11,16,17].…”

“…HIV infection has been implicated as the etiological factor in many published cases of PRES [8,9,11,13]. HIV virus has been shown to induce endothelial cell apoptosis, tight junction disruption, oxidative stress, and the expression of pro-inflammatory cytokines and adhesion molecules which stimulate endothelial cell inflammation, all of which culminates in BBB dysfunction [11,16,17]. Most reported cases of PRES occurred in patients with low CD4 counts (range 16–284 cells/ μ l) [9,13,18–21], however, HIV-induced pathology has not been shown to be related to viral load [22].…”

“…Typical magnetic resonance imaging (MRI) findings include vasogenic edema in the subcortical white matter of the posterior parietal and occipital regions bilaterally, but additional cortical and anterior findings are possible as well [3–6]. Severe hypertension, abrupt increases in blood pressure, renal disease, pre-eclampsia and eclampsia, autoimmune disease, immunodeficiency states including human immunodeficiency virus infection (HIV) and use of immunosuppressants or immune modulators are the most commonly implicated causes [2,4,7–11]. The clinical and neuroradiologic findings of PRES are non-specific and may mimic other neurologic conditions, posing a diagnostic difficulty, especially in patients with multiple co-morbidities.…”

Leucopatía reversible de la protuberancia: en paciente con SIDA y tratamiento retroviral

“…La aparición de la LPR no fue atribuida a efectos neurotóxicos originados por el tratamiento, los autores sólo realzaron la acción hipertensiva de los antirretrovirales 18,19 . Sin embargo, Tonioka et al, describieron un paciente con SIDA, no hipertenso y en tratamiento antiretroviral, quien desarrolló una LPR localizado en la protuberancia, una leucopatía reversible de la protuberancia.…”