Daphne Angelie Sevilleja
Systemic lupus erythematosus (SLE) is known to be a multisystem autoimmune disorder. Neuropsychiatric manifestations of systemic lupus erythematosus (SLE) are heterogenous and complex. Posterior reversible encephalopathy syndrome (PRES) and its association with SLE has increasingly, been recognized. PRES as an initial manifestation of SLE is not widely reported in the literature. A case control study reported prevalence of PRES in SLE as much as 0.43%. Common presentations include headache, vomiting, altered mental function, visual symptoms, and seizures. Diagnosis is supported by classical symptoms and typical radiological feature of bilateral posterior subcortical brain edema on magnetic resonance imaging (MRI). PRES is linked with accelerated hypertension, renal impairment, eclampsia, pre-eclampsia, sepsis, cytotoxic therapy, underlying autoimmune diease, and immunosuppressive therapy. Objectives: To study the clinical profile of posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus (SLE) patient and determine the risk factors associated with it.Case presentation: A 26 year old Filipino female diagnosed with SLE. Overall, the disease was not well controlled due to patients non-compliance to therapy. She was brought to the emergency department due to sudden generalized tonic-clonic seizure episode. Cranial MRI revealed posterior reversible encephalopathy syndrome (PRES) and was admitted. Conclusion: PRES occurs in young lupus patients and in the early part of the disease. Focal deficits are not uncommon. It can be the presenting manifestation of lupus. Management is predominantly symptomatic. Immunosuppression is directed by other major organ manifestations. Early diagnosis and appropriate management is productive. Systemic lupus erythematosus should be considered in the differential diagnosis of patients who present with PRES. One should have a low threshold for magnetic resonance imaging especially when neurological symptoms occur in young women with or without an established diagnosis of SLE and especially among those with active SLE, lupus nephritis, renal failure, and/or poorly controlled hypertension. Given the good prognosis of PRES in SLE patients with early supportive treatment, prompt recognition is crucial to institute appropriate management.