Post-streptococcal glomerulonephritis leading to posterior reversible encephalopathy syndrome: a case report

BMC Research Notes

Gayani Premawansa¹  Sharmila Thamotheram¹  Indika Marasingha¹  Dilani Priyangika¹  Madura Adikari¹ 

[1] Colombo North Teaching Hospital, Ragama, Sri Lanka

关键词: Sri Lanka;    Hypertensive encephalopathy;    Post-streptococcal glomerulonephritis;    T2 weighted magnetic resonance imaging;    Posterior reversible encephalopathy syndrome;   

Others  :  1129496
DOI  :  10.1186/1756-0500-7-644

 received in 2014-02-22, accepted in 2014-09-10,  发布年份 2014

【 摘 要 】

Background

Posterior reversible encephalopathy syndrome is a clinical radiographic syndrome of heterogeneous etiologies. Developing hypertensive encephalopathy following post-streptococcal glomerulonephritis is a known but uncommon manifestation and developing posterior reversible encephalopathy syndrome in such a situation is very rare. We report a case with contrast-enhanced computed tomography and magnetic resonance imaging findings of posterior reversible encephalopathy syndrome in the background of acute post-streptococcal glomerulonephritis.

Case presentation

A thirteen- year -old Sri Lankan boy presented with a focal fit by way of secondary generalization with duration of 10 minutes, and developed 2 similar fits subsequently following admission. He later developed severe hypertension with evidence of glomerulonephritis, which was diagnosed as acute post-streptococcal glomerulonephritis. A contrast-enhanced computed tomography imaging of brain done on day-3 revealed non-enhancing low-attenuating areas in fronto -parietal regions. A T2 weighted film of magnetic resonance imaging was done on day-10 of the admission and found to have linier sub-cortical hyper intensities in both parietal regions which were compatible with the radiological diagnosis of posterior reversible encephalopathy syndrome.

Conclusion

Post-streptococcal glomerulonephritis is an important cause of acute nephritic syndrome especially in children. This case report illustrates a rare association of posterior reversible encephalopathy syndrome in a patient with post-streptococcal glomerulonephritis.

【 授权许可】

   
2014 Adikari et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Gupta S, Goyl VK, Talukdar B: Reversible posterior leucoencephalopathy syndrome in post- streptococcal glomerulonephritis. Indian Pediatr 2010, 47:274-6.
• [2]Dasgupta MK, Sarkar S, Patra C: Posterior reversible encephalopathy syndrome in a case of post-streptococcal glomerulonephritis. Journal of Pediatric Sciences 2013, 5:e192.
• [3]Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR: A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996, 334:494-500.
• [4]Wilson SE, de Groen PC, Aksamit AJ, Wiesner RH, Garrity JA, Krom RA: Cyclosporin- A induced reversible cortical blindness. J Clin Neuroophthalmol 1988, 8:215-20.
• [5]Ay H, Buonanno FS, Schaefer PW, Le DA, Wang B, Gonzalez RG, Koroshetz WJ: Posterior leuco-encephalopathy without severe hypertension: Utility of diffusion-weighted MRI. Neurology 1998, 51:1369-76.
• [6]Ahn KJ, Lee JW, Hahn ST, Yang DW, Kim PS, Kim HJ, Kim CC: Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. AJR Am J Roentgenol 1995, 165:627-31.
• [7]Ergun T, Lakadamyali H, Yilmaz A: Recurrent posterior reversible encephalopathy syndrome in a hypertensive patient with end-stage renal disease. Diagn Interv Radiol 2008, 14:182-5.
• [8]Covarrubias DJ, Luetmer PH, Campeau NG: Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. Am J Neuroradiol 2002, 23:1038-48.
• [9]Lee H-J: Posterior reversible encephalopathy syndrome. [http://www.medscape.com/viewarticle/559553 webcite]
• [10]Lee VH, Wijdicks EF, Manno EM, Rabinstein AA: Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008, 65(2):205-210.
• [11]Nissenson AR, Baraff LJ, Fine RN, Knutson DW: Post-streptococcal acute glomerulonephritis: fact and controversy. Ann Intern Med 1979, 91(1):76-86.