title: Posterior reversible encephalopathy syndrome in Korean patients with systemic lupus erythematosus: risk factors and clinical outcome.
abstract: Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurologic condition associated with systemic lupus erythematosus (SLE). This study aimed to demonstrate the risk factors and clinical outcome of PRES in patients with SLE. Fifteen patients with SLE were diagnosed with PRES by characteristic clinical manifestations and magnetic resonance imaging (MRI) features from 2000 to 2012. Clinical profiles and outcomes were assessed for this study population. Additionally, 48 SLE patients with neurologic symptoms who underwent brain MRI were included for comparative analyses. The median age and duration of SLE in patients with PRES was 27 and 6.1 years, respectively. Comparison between patients with and without PRES revealed significant differences in the presentation of hypertension and seizure, lupus nephritis with renal insufficiency, treatment with high-dose steroid and cyclophosphamide, recent transfusion, and lupus activity measured by SLE disease activity index. Renal failure was the single independent factor with a high odds ratio of 129.250 by multivariate analysis. Of 15 patients, four experienced relapse and two died of sepsis during hospitalization. Our results suggest that lupus nephritis with renal dysfunction and other related clinical conditions can precede the occurrence of PRES in patients with SLE. It is important to perform early brain imaging for a timely diagnosis of PRES when clinically suspected.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, South Korea.
authors.forename: S M
authors.initials: SM
authors.lastname: Jung
authors.forename: S-J
authors.initials: SJ
authors.lastname: Moon
authors.forename: S-K
authors.initials: SK
authors.lastname: Kwok
authors.forename: J H
authors.initials: JH
authors.lastname: Ju
authors.forename: K-S
authors.initials: KS
authors.lastname: Park
authors.forename: S-H
authors.initials: SH
authors.lastname: Park
authors.forename: H-Y
authors.initials: HY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008181:Lupus Nephritis / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015999:Multivariate Analysis; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology* / Q000503:physiopathology; D012008:Recurrence; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology*; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: Posterior reversible encephalopathy syndrome; lupus nephritis; renal failure; renal insufficiency; systemic lupus erythematosus