Case Report
 
Postoperative posterior reversible encephalopathy syndrome as initial presentation of systemic lupus erythematosus
Joshua Sunny George1, Shahil Mehta1, Patricia Calvo1
1University of Miami Miller School of Medicine, Miami, FL, USA

Article ID: Z01201801CR10871JG
doi: 10.5348/ijcri-201802-CR-10871

Corresponding Author:
Joshua Sunny George,
82 Gordon Drive, Troy, Michigan,
USA, 48098

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How to cite this article
George JS, Mehta S, Calvo P. Postoperative posterior reversible encephalopathy syndrome as initial presentation of systemic lupus erythematosus. Int J Case Rep Images 2018;9(1):20–24.


ABSTRACT

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.

Keywords: Hypertension, Posterior reversible encephalopathy syndrome, Systemic lupus erythematosus, Total hysterectomy



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Author Contributions
Joshua Sunny George – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shahil Mehta – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Patricia Calvo – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2018 Joshua Sunny George et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.