Journal List > J Rheum Dis > v.20(2) > 1064025

Lee, Lee, Ahn, Ryu, Song, and Lee: Cyclophosphamide-induced Posterior Reversible Encephalopathy Syndrome in a Patient with Lupus Nephritis

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neurologic condition characterized by vasogenic edema on neuroimaging and is associated with the setting of severe hypertension, eclampsia, autoimmune disease, malignancy, and immunosuppressive drugs. We report on a 42 year-old female systemic lupus erythematous patient who presented altered consciousness, seizure, and visual disturbance after cyclophosphamide pulse therapy. Magnetic resonance imaging (MRI) showed multifocal high signal intensity lesions in the parieto-occipital cortex bilaterally and in the subcortical white matter. Her condition was improved and her MRI lesions were resolved after aggressive blood pressure control and high-dose steroid treatment. It is possibly the first reported case of PRES in a patient with lupus, treated with cyclophosphamide pulse therapy during a nephritis flare in Korea.

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Figure 1.
Brain CT imaging showed asymmetrical diffuse low density lesions in bilateral parieto-occipital lobes.
jrd-20-103f1.tif
Figure 2.
Brain FLAIR MRI imaging showed asymmetrical diffuse high signal intensities lesions in bilateral parieto-occipital lobes.
jrd-20-103f2.tif
Figure 3.
Followup Brain FLAIR MRI after 7 days of imaging showed marked resolution process of the preexisting diffuse high signal intensities lesions.
jrd-20-103f3.tif
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