J Korean Rheum Assoc.  2007 Sep;14(3):291-296. 10.4078/jkra.2007.14.3.291.

Reversible Posterior Leukoencephalopathy Syndrome in a Patient withSystemic Lupus Erythematosus Treated with Cyclosporine

• Shin JD
• Son JY
• Kim DY
• Park JH
• Kim GW
• Song EJ
• Kim JM
• Kim KH
• Nam EJ
• Kang YM

• KMID: 2202181
• DOI: http://doi.org/10.4078/jkra.2007.14.3.291

Abstract

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, seizure, altered mental status and visual impairment. Neuroimaging shows reversible white matter edema predominantly in the parietal and occipital lobes. RPLS has been associated with a variety of conditions, including hypertensive encephalopathy, renal failure, immunosupressive therapy, and autoimmune diseases such as systemic lupus erythematosus (SLE). We report a young woman of SLE presented with headache, generalized tonic-clonic seizure and altered mental status, after taking azathioprine and cyclosporine. The brain magnetic resonance images showed bilateral hyperintensitiy in the posterior parietal, occipital, temporal lobes and cerebellum on T2-weighted images and fluid attenuated inversion recovery images, whereas diffusion-weighted images showed isointensity in the same distribution. The patient was improved clinically and radiologically one week after the control of hypertension and discontinuation of cyclosporine.

Keyword

Reversible posterior leukoencephalopathy syndrome; Systemic lupus erythematosus; Cyclosporine

MeSH Terms

Autoimmune Diseases
Azathioprine
Brain
Cerebellum
Cyclosporine*
Edema
Female
Headache
Humans
Hypertension
Hypertensive Encephalopathy
Lupus Erythematosus, Systemic
Neuroimaging
Occipital Lobe
Posterior Leukoencephalopathy Syndrome*
Rabeprazole
Renal Insufficiency
Seizures
Temporal Lobe
Vision Disorders
Azathioprine
Cyclosporine

Figure

• 

  Fig. 1. At admission, axial T2-weighted image, (A) showed bilaterally high signal intensity in the occipital and temporal lobes, and coronal FLAIR image, (B) showed high signal intensity in the cerebellum, parietal and temporal lobes of both side. Axial diffusion-weighted images, (C,D) showed isointensity in the cerebellum, occipital and temporal lobes. One week later, axial T2-weighted image, (E) and coronal FLAIR image, (F) showed almost complete resolution of previous lesions.

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