Posterior reversible encephalopathy syndrome in a patient with hepatitis B induced type 1 membranoproliferative glomerulonephritis.
Posterior reversible encephalopathy syndrome (PRES) is a rare complication of nephrotic syndrome and corticosteroid therapy. Here, we discuss an 18 year old man with type 1 membranoproliferative glomerulonephritis (MPGN) secondary to hepatitis B infection who developed posterior leukoencephalopathy while on therapy with lamivudine and prednisone. He developed seizures and vision loss. He also had hypertension, but no sudden elevation was recorded at any time. Magnetic resonance imaging revealed patchy areas of altered signal intensity involving cortical gray and subcortical white matter in the bilateral frontoparietal regions, occipital cortices, temporal cortices and cerebellar hemispheres, and hyperintensity on T2W and FLAIR sequences. Tapering of prednisone and controlling hypertension resulted in clinical improvement within a few days, and in a month MRI was normal. Diagnosing PRES requires a high index of suspicion when treating similarly susceptible patients. PRES as a complication during the treatment of MPGN secondary to hepatitis B has, to our knowledge, never been reported previously in the literature.
Sathyanarayanan
Vishwanath
V
Department of Medicine, Kasturba Medical College, # 1, OPD Block, Manipal 576104, Karnataka, India. docvishu@gmail.com
Razak
Abdul
A
Narayan
Girish
G
Prabhu
Mukhyaprana
M
Ramachandran
Balasubramanian
B
Ranjini
Kudva
K
Vidya
Monappa
M
Joshi
Kusum
K
D000293:Adolescent; D004660:Encephalitis / Q000209:etiology*; D015432:Glomerulonephritis, Membranoproliferative / Q000209:etiology*; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000150:complications; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D013577:Syndrome
D007166:Immunosuppressive Agents