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A case of posterior reversible encephalopathy syndrome associated with sepsis

Orlando Garner1, Ana Ramirez1, Alfredo Iardino1

  • 1Department of Internal Medicine, Texas Tech University Health Science Center at Permian Basin, Odessa, Texas, USA.

BMJ Case Reports
|July 12, 2018
PubMed

Insights

Posterior reversible encephalopathy syndrome (PRES) can be caused by Staphylococcus aureus sepsis. This case report highlights a young diabetic patient who recovered quickly after treatment for PRES and sepsis.

Area of Science:

  • Neurology
  • Radiology
  • Infectious Diseases

Background:

  • Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by vasogenic edema.
  • Infection and sepsis are potential, though less common, causes of PRES.
  • Type 1 diabetes mellitus and Staphylococcus aureus bacteremia are relevant patient comorbidities.

Observation:

  • A 19-year-old immunocompetent male with type 1 diabetes presented with acute visual loss, headaches, and hypertension.
  • Recent history of severe diabetic ketoacidosis and Staphylococcus aureus bacteremia.
  • Initial CT was negative; MRI revealed findings suggestive of PRES.

Findings:

  • The patient was diagnosed with PRES, likely secondary to Staphylococcus aureus sepsis.
  • Treatment with nicardipine for blood pressure management led to symptom resolution within 4 days.
  • This case underscores the association between gram-positive bacterial sepsis and PRES.

Implications:

  • PRES, while rare, is increasingly recognized with advanced imaging availability.
  • The findings expand the known associations of PRES beyond typical triggers like autoimmune diseases or cytotoxic therapies.
  • Prompt recognition and management of both PRES and underlying sepsis are crucial for favorable outcomes.
Keywords:
epilepsy and seizuresintensive careneuroimagingneurology

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