Mycophenolate-Induced Posterior Reversible Encephalopathy Syndrome.

Area of Science:

• Nephrology
• Neurology
• Rheumatology

Background:

• Systemic lupus erythematosus (SLE) can manifest with severe renal involvement, including lupus nephritis.
• Lupus nephritis, particularly with rapidly progressive glomerulonephritis, requires aggressive immunosuppressive therapy.
• Treatment complications, such as posterior reversible encephalopathy syndrome (PRES), can occur in patients with autoimmune diseases.

Observation:

• A 29-year-old woman with stage IV lupus nephritis and anti-dsDNA positive, ANA negative lupus presented with acute kidney injury and hemolytic anemia.
• Initial treatment included mycophenolate, hemodialysis, and high-dose corticosteroids.
• Four days post-discharge, she experienced a seizure, altered mental status, and was diagnosed with PRES based on MRI findings.

Findings:

• PRES was diagnosed due to bilateral posterior subcortical edema on MRI.
• Mycophenolate was discontinued and replaced with cyclophosphamide.
• Intensive blood pressure management was crucial for resolving PRES symptoms and imaging findings.

Implications:

• This case underscores the importance of considering PRES in patients with lupus nephritis presenting with neurological symptoms, especially after initiating immunosuppressive therapy.
• Aggressive blood pressure control is paramount in managing PRES.
• Early diagnosis and appropriate management, including medication adjustment, can lead to favorable neurological outcomes in PRES associated with lupus nephritis.