title: Systemic lupus erythematosus complicated with posterior reversible encephalopathy syndrome and intracranial vasculopathy.
abstract: Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition characterized by reversible vasogenic edema on neuroimaging. It is associated with various neurological manifestations, including headaches, vomiting, seizures, visual loss, altered mental status and focal neurological deficits. PRES mainly occurs in the setting of eclampsia, hypertension, uremia, malignancy, transplantation, autoimmune diseases and/or use of immunosuppressive drugs. This syndrome has been described in patients with systemic lupus erythematosus (SLE). PRES is a potentially reversible clinical-radiological entity; however, it can be complicated with vasculopathy, infarction or hemorrhage. Vasculopathy has been demonstrated to be a common finding in patients with SLE. We report the case of a woman with lupus nephritis and PRES whose diffuse vasculopathy was present on initial neuroimaging. Subsequent brain computed tomography scan demonstrated interval development of intraparenchymal hemorrhage and subarachnoid hemorrhage. To our knowledge, this unique brain image pattern has not been reported in SLE patients.
authors.affiliation: Divisions of Allergy-Immunology-Rheumatology, Chi Mei Medical Center, Tainan.
authors.forename: Hung-An
authors.initials: HA
authors.lastname: Chen
authors.forename: Yeong-Jang
authors.initials: YJ
authors.lastname: Lin
authors.forename: Pei-Chih
authors.initials: PC
authors.lastname: Chen
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chen
authors.forename: Kao-Chang
authors.initials: KC
authors.lastname: Lin
authors.forename: He-Hsiung
authors.initials: HH
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001929:Brain Edema / Q000209:etiology; D002533:Cerebral Angiography / Q000379:methods; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D038524:Diffusion Magnetic Resonance Imaging; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008181:Lupus Nephritis / Q000188:drug therapy / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D005938:Glucocorticoids