Electrolyte Blood Press.  2017 Sep;15(1):12-16. 10.5049/EBP.2017.15.1.12.

Unusual Case of Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-glomerular Basement Membrane Antibody Glomerulonephritis: A Case Report and Review of the Literature

• Cha B
• Kim DY
• Jang H
• Hwang SD
• Choi HJ
• Kim MJ

• KMID: 2391007
• DOI: http://doi.org/10.5049/EBP.2017.15.1.12

Abstract

Posterior reversible encephalopathy syndrome (PRES) is characterized by a clinical and radiological entity with the sudden onset of seizures, headache, altered consciousness, and visual disturbances in patients with the findings of reversible vasogenic subcortical edema without infarction. Hypertension, renal disease, and autoimmune disease are co-morbid conditions of PRES. Nevertheless, there have only been a few case reports of PRES in a patient with anti-glomerular basement membrane antibody glomerulonephritis (anti-GBM GN). This paper presents the possible first Korean case of a 36-year-old woman with the striking features of PRES. She presented with a sudden onset of visual blindness, headache, and seizure. The brain MRI images revealed hyperintense lesions in both the occipital and parietal lobes, which suggested vasogenic edema. Three months before this presentation, she was diagnosed with anti-GBM GN. Since then, she underwent immunosuppression with cyclophosphamide and steroid, and hemodialysis for renal failure with a treatment of anti-GBM GN.

Keyword

Posterior reversible encephalopathy syndrome; Anti-glomerular basement membrane antibody glomerulonephritis; Hypertension; Cyclophosphamide

MeSH Terms

Adult
Autoimmune Diseases
Basement Membrane*
Blindness
Brain
Consciousness
Cyclophosphamide
Edema
Female
Glomerulonephritis*
Headache
Humans
Hypertension
Hypertension, Renal
Immunosuppression
Infarction
Magnetic Resonance Imaging
Parietal Lobe
Posterior Leukoencephalopathy Syndrome*
Renal Dialysis
Renal Insufficiency
Seizures
Strikes, Employee
Cyclophosphamide

Figure

• 

  Fig. 1 (A) Crescentic glomerulus was observed in the renal biopsy and size of glomerulus was markedly enlarged (Periodic acid-Schiff, Hematoxylin-Eosin stain, ×200). (B) Linear infiltration of IgG was shown along the glomerulus basement membrane (GBM). (C) Ruptured GBM was observed by electron microscopy (×5,000).

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  Fig. 2 Course of treatment from diagnosis of anti-GBM disease to presentation of neurologic symptoms of PRES.

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  Fig. 3 Brain MRI Images of the patient.(A) Several high signals were observed in the bilateral occipital area on the T2-weighted Flair images, suggesting vasogenic edema due to the extravasation of fluid. (B) Reduced T2 high signal were observed in the cortex and subcortex of the parieto-occipital lobes bilaterally on the 14th hospital day.

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