Systemic lupus erythematosus associated with posterior reversible encephalopathy syndrome: a case report
Abstract
Case presentation: A 16-year-old male patient initially presented with bacterial tonsillitis, progressing to lower limb swelling, dyspnea and headache. He sought hospital care which revealed hematuria and pleural effusion, and was treated for pneumonia with levofloxacin. After 10 days, he developed two episodes of seizures lasting 10 minutes each, with tonic-clonic tremors, and came to our service. On admission, he had hypertension 160/90mmHg, a positive Brudzinski sign and new seizure episodes. Pulse therapy of 1mg/kg methylprednisolone was carried out in the suspicion of autoimmune encephalitis and the patient showed clinical improvement. The electroencephalogram showed moderately disorganized baseline activity with an excess of slow rhythms in the delta band superimposed by faster rhythms in the alpha band, as well as intermittent rhythmic delta activity in the fronto-temporal regions and a slow sharp wave epileptiform discharge with greater electronegativity in C3P3. Laboratory tests revealed: C3 consumed (< 11), CH 50 consumed, C4 normal, FAN positive ( AC-4) (AC-8) 1:320, ASLO positive (349.9), proteinuria of 3.8g. Partial urine test with leukocyturia and hematuria. Magnetic Resonance Imaging (MRI) of the skull showed hypointense signals in T1, hyperintense in T2/ FLAIR, without diffusion restriction and gadolinium impregnation, indicating PRES. Treatment for SLE was started in conjunction with rheumatology. Control MRI of the skull identified a significant reduction…
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