title: Reversible posterior leukoencephalopathy in a patient with Wegener granulomatosis.
abstract: A 14-year-old girl with rapidly progressive glomerulonephritis was transferred to our hospital because of acute renal failure. A diagnosis of Wegener granulomatosis was made according to the symptom triad of a renal biopsy demonstrating crescentic glomerulonephritis, severe sinusitis, and serological findings of raised proteinase 3 anti-neutrophil cytoplasmic antibody level. In spite of combination therapy with methylprednisolone, cyclophosphamide, and plasma exchange, her renal function gradually deteriorated. Thereafter, she suffered a severe headache and generalized seizures. Brain computed tomography (CT) scan revealed bilateral low-density areas in the parieto-occipital lobes. Magnetic resonance imaging (MRI) disclosed a high-intensity area on T2-weighted images and a low-signal intensity area on T1-weighted images in the same lesion. Follow-up brain CT scan 3 weeks and MRI 2 months after the first studies showed complete resolution of the abnormal lesions, which indicated reversible posterior leukoencephalopathy syndrome. In addition to renal failure, hypertension, and cyclophoshamide, the primary disease may have played a role in the development of this uncommon syndrome in our patient.
authors.affiliation: Department of Pediatrics, Hiroshima Prefectural Hospital, Hiroshima, Japan. ohtaotachan1@aol.com
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ohta
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakano
authors.forename: Mami
authors.initials: M
authors.lastname: Shiotsu
authors.forename: Takeki
authors.initials: T
authors.lastname: Furue
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ohtani
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Mizoue
authors.forename: Katsuzo
authors.initials: K
authors.lastname: Kiya
authors.forename: Issei
authors.initials: I
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001927:Brain Diseases / Q000209:etiology*; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000503:physiopathology*; D006261:Headache / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008279:Magnetic Resonance Imaging; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed