PRES in Lupus Nephritis and Sickle Cell Trait: A Diagnostic and Therapeutic Challenge


Authors : Dr. Ashruti Agrawal; Dr. Bhamidipaty Kanaka Durga Prasad; Dr. Kesinakurthi Satish Kumar; Dr. Tallapaneni Kiran

Volume/Issue : Volume 10 - 2025, Issue 6 - June


Google Scholar : https://tinyurl.com/yc58w9kj

DOI : https://doi.org/10.38124/ijisrt/25jun863

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.


Abstract : Posterior reversible encephalopathy syndrome (PRES) is a rare, potentially reversible clinico-radiological condition affecting a small percentage of patients with systemic lupus erythematosus (SLE). This case report describes a 26- year-old female with SLE and type IV lupus nephritis who presented with seizures, altered sensorium, and hypertension. MRI revealed bilateral symmetrical T2/FLAIR hyperintensities in multiple brain regions, confirming PRES. Despite intensive management, including antihypertensive and anticonvulsant therapy and extraventricular drain placement for hydrocephalus, the patient developed multiorgan dysfunction and succumbed following cardiac arrest. This case underscores the importance of considering PRES in young females with SLE presenting with neurological symptoms and highlights the need for prompt radiological diagnosis and management to prevent irreversible damage or death.

Keywords : Hypertension; Lupus Nephritis; Posterior Reversible Encephalopathy Syndrome.

References :

  1. Liu B, Zhang X, Zhang FC, et al. Posterior reversible encephalopathy syndrome could be an underestimated variant of “reversible neurological deficits” in systemic lupus erythematosus. BMC Neurol. 2012;12:152. doi:10.1186/1471-2377-12-152.
  2. Mikdashi J, Nived O. Measuring disease activity in adults with systemic lupus erythematosus: the challenges of administrative burden and responsiveness to patient concerns in clinical research. Arthritis Res Ther. 2015;17:1-10. doi:10.1186/s13075-015-0702-6.
  3. Merayo-Chalico J, Barragán-Martínez C, Rodríguez-Jiménez P, et al. Clinical outcomes and risk factors for posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a multicentric case–control study. J Neurol Neurosurg Psychiatry. 2016;87(3):287-94. doi:10.1136/jnnp-2014-310404.
  4. Vaysman T, Xu P, Vartanian T, et al. “Highlighting” red nuclei by atypical posterior reversible encephalopathy syndrome in a patient with systemic lupus erythematosus. Clin Case Rep. 2019;7(7):1404-8. doi:10.1002/ccr3.2247.
  5. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494-500. doi:10.1056/NEJM199602223340803.
  6. Ellis CA, McClelland AC, Mohan S, et al. Cerebrospinal fluid in posterior reversible encephalopathy syndrome: implications of elevated protein and pleocytosis. Neurohospitalist. 2019;9(2):58-64. doi:10.1177/1941874418802061.
  7. Afilal I, Nasri S, Bendaoud M, et al. Fatal outcome of posterior reversible encephalopathy syndrome (PRES) in a lupus nephropathy patient: a case report. Radiol Case Rep. 2022;17(6):2215-9. doi:10.1016/j.radcr.2022.03.084.
  8. Thust SC, Burke C, Siddiqui A. Neuroimaging findings in sickle cell disease. Br J Radiol. 2014;87(1040):20130699. doi:10.1259/bjr.20130699.
  9. Kwon S, Koo J, Lee S. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Pediatr Neurol. 2001;24(5):361-364. doi:10.1016/S0887-8994(01)00265-X.
  10. Antunes NL, Small TN, George D, et al. Posterior leukoencephalopathy syndrome may not be reversible. Pediatr Neurol. 1999;20(3):241-3. doi:10.1016/S0887-8994(98)00244-2.

Posterior reversible encephalopathy syndrome (PRES) is a rare, potentially reversible clinico-radiological condition affecting a small percentage of patients with systemic lupus erythematosus (SLE). This case report describes a 26- year-old female with SLE and type IV lupus nephritis who presented with seizures, altered sensorium, and hypertension. MRI revealed bilateral symmetrical T2/FLAIR hyperintensities in multiple brain regions, confirming PRES. Despite intensive management, including antihypertensive and anticonvulsant therapy and extraventricular drain placement for hydrocephalus, the patient developed multiorgan dysfunction and succumbed following cardiac arrest. This case underscores the importance of considering PRES in young females with SLE presenting with neurological symptoms and highlights the need for prompt radiological diagnosis and management to prevent irreversible damage or death.

Keywords : Hypertension; Lupus Nephritis; Posterior Reversible Encephalopathy Syndrome.

CALL FOR PAPERS


Paper Submission Last Date
30 - June - 2025

Paper Review Notification
In 2-3 Days

Paper Publishing
In 2-3 Days

Video Explanation for Published paper

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe