Postoperative posterior reversible encephalopathy syndrome as initial presentation of systemic lupus erythematosus

Joshua Sunny George ； Shahil Mehta ； Patricia Calvo

《International Journal of Case Reports and Images (IJCRI)》 9卷1期 (2018/06) Pp. 20-24

https://doi.org/10.5348/ijcri-201802-CR-10871

摘要

Introduction: Posterior reversible leukoencephalopathy syndrome (PRES) is a syndrome consisting of neurological symptoms including headaches, visual changes, and seizures often occurring in the setting of uncontrolled hypertension. Diagnosis is often confirmed by characteristic findings on neuroimaging studies. Case Report: We present a case of a 25-year-old African-American woman with a history of chronic pelvic pain secondary to recurrent endometriosis presenting with chief complaints of fever and pelvic pain. She was treated with laparoscopic ablation three months prior. Workup revealed bilateral tubo-ovarian abscesses and the patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Postoperatively, the patient had new onset hypertension which eventually lead to a seizure episode. The patient was transferred to the ICU, started on nicardipine and Keppra and her hypertension improved within several hours. Neuroimaging findings on MRI scan revealed lesions in the occipital and parietal lobes consistent with PRES. Outpatient workup conducted several months afterwards uncovered a diagnosis of systemic lupus erythematosus, leading us to conclude that the postoperative hypertensive emergency and PRES were secondary to undiagnosed SLE. Conclusion: The rare complication of PRES has been described in a variety of settings including SLE in which endothelial dysfunction of the intracerebral vasculature leads to characteristic PRES symptoms. Patients, especially those in the postoperative setting covered by multiple specialty providers, with new onset hypertension and neurological symptoms should warrant further workup as they may indicate underlying etiologies such as SLE or other described risk factors for PRES.

關鍵字

Hypertension ； Posterior reversible encephalopathy syndrome ； Systemic lupus erythematosus ； Total hysterectomy