J Rheum Dis.  2013 Apr;20(2):103-107. 10.4078/jrd.2013.20.2.103.

Cyclophosphamide-induced Posterior Reversible Encephalopathy Syndrome in a Patient with Lupus Nephritis

• Lee CH
• Lee YM
• Ahn SH
• Ryu DW
• Song JH
• Lee MS

• KMID: 2223034
• DOI: http://doi.org/10.4078/jrd.2013.20.2.103

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neurologic condition characterized by vasogenic edema on neuroimaging and is associated with the setting of severe hypertension, eclampsia, autoimmune disease, malignancy, and immunosuppressive drugs. We report on a 42 year-old female systemic lupus erythematous patient who presented altered consciousness, seizure, and visual disturbance after cyclophosphamide pulse therapy. Magnetic resonance imaging (MRI) showed multi-focal high signal intensity lesions in the parieto-occipital cortex bilaterally and in the subcortical white matter. Her condition was improved and her MRI lesions were resolved after aggressive blood pressure control and high-dose steroid treatment. It is possibly the first reported case of PRES in a patient with lupus, treated with cyclophosphamide pulse therapy during a nephritis flare in Korea.

Keyword

Posterior reversible encephalopathy syndrome; Systemic lupus erythematosus; Cyclophosphamide

MeSH Terms

Autoimmune Diseases
Blood Pressure
Consciousness
Cyclophosphamide
Eclampsia
Edema
Female
Humans
Hypertension
Korea
Lupus Erythematosus, Systemic
Lupus Nephritis
Magnetic Resonance Imaging
Nephritis
Neuroimaging
Pregnancy
Seizures
Cyclophosphamide

Figure

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  Figure 1. Brain CT imaging showed asymmetrical diffuse low density lesions in bilateral parieto-occipital lobes.

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  Figure 2. Brain FLAIR MRI imaging showed asymmetrical diffuse high signal intensities lesions in bilateral parieto-occipital lobes.

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  Figure 3. Followup Brain FLAIR MRI after 7 days of imaging showed marked resolution process of the preexisting diffuse high signal intensities lesions.

Reference

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