Abstract
Background
Posterior reversible encephalopathy syndrome (PRES) is characterized by abnormalities in cerebral white matter and neurologic symptoms. It can be caused by immunosuppressive drugs or autoimmune diseases. We describe a case of PRES in a patient with collapsing focal glomeruloesclerosis (collapsing FGS) with complete recovery after withdrawal of cyclosporine (CSA).
Case report
A 27-year-old male presented a corticosteroid-resistant nephrotic syndrome secondary to collapsing FGS corticosteroid. Treatment with CSA was started after a nonresponding course of prednisone. Three weeks later, he developed an abrupt elevation of blood pressure (210/120 mmHg), with headaches, mental confusion, and generalized seizures. Magnetic resonance imaging (MRI) showed lesions suggestive of PRES. CSA was withdrawn, and a new MRI was normal after 2 months.
Conclusions
PRES is a rare syndrome that must be suspected in every patient presenting neurologic symptoms in the course of immunosuppression. It can be induced by CSA and is totally reversible when the drug is rapidly withdrawn.
References
Heiss S, Krampla W, Klauser-Braun R (2006) A patient recent transplanted with a living donor kidney develops severe neurological symptoms. Nephrol Dial Transplant 21:2017–2019
Hinchey J, Chaves C, Appignani B et al (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334:494–500
Garg RK (2001) Posterior leukoencephalopathy syndrome. Postgrad Med J 77:24–28
Adams DH, Ponsford S, Gunson B et al (1987) Neurological complications following liver transplantation. Lancet 1:949–951
Antunes NL, Small TN, George D, Boulad F, Lis E (1999) Posterior leukoencephalopathy syndrome may not be reversible. Pediatr Neurol 20:241–243
El Karoui K, Le Quintrec M, Dekeyser E, Servais A, Hummel A, Fadel F, Fakhouri F (2008) Posterior reversible encephalopathy syndrome in systemic lupus erythematosus. Nephrol Dial Transplant 23:757–763
Cosottini M, Lazzarotti G, Ceravolo R, Michelassi MC, Canapicchi R, Murri L (2003) Cyclosporine-related posterior reversible encephalopathy syndrome (PRES) in non-transplant patient: a case report and literature review. Eur J Neurol 10:461–462
Sheashaa H, Mahmoud I, El-Basuony F et al (2007) Does cyclosporine achieve a real advantage for treatment of idiopathic nephrotic syndrome in children? A long-term efficacy and safety study. Int Urol Nephrol 39:923–928
Lee VH, Wijdicks EF, Manno EM, Rabinstein AA (2008) Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 65:205–210
Lim MH, Kim DW, Cho HS, Lee HJ, Kim HJ, Park KJ, Chang SH, Park DJ (2008) Isolated cerebellar reversible leukoencephalopathy syndrome in a patient with end stage renal disease. Intern Med 47:43–45
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de Oliveira, R.A., Fechine, L.M., Neto, F.C. et al. Posterior reversible encephalopathy syndrome (PRES) induced by cyclosporine use in a patient with collapsing focal glomeruloesclerosis. Int Urol Nephrol 40, 1095–1098 (2008). https://doi.org/10.1007/s11255-008-9431-y
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DOI: https://doi.org/10.1007/s11255-008-9431-y