Case 279: Central-Variant Posterior Reversible Encephalopathy Syndrome

Area of Science:

• Neurology
• Nephrology
• Immunology

Background:

• A 25-year-old woman with newly diagnosed systemic lupus erythematosus (SLE) and class IV lupus nephritis presented with edema.
• She was treated with mycophenolate mofetil, methylprednisolone, furosemide, and C1 esterase inhibitor.

Observation:

• The patient experienced a generalized tonic-clonic seizure, hypoxia, and required intubation.
• Laboratory findings revealed severe hyponatremia (122 mEq/L), which was corrected over 48 hours.
• Subsequent hospital course included renal failure, hypertension, anemia, thrombocytopenia, and pneumonia.

Findings:

• Post-extubation, the patient exhibited neurological deficits including right gaze preference, drowsiness, nystagmus, ophthalmoplegia, and generalized weakness.
• Brain MRI and MR angiography showed no evidence of intracranial hemorrhage or edema.
• Temporal artery biopsy was normal, ruling out vasculitis.

Implications:

• This case highlights the potential for severe neurological manifestations in lupus nephritis, possibly related to hyponatremia.
• It underscores the importance of comprehensive neurological assessment and management in SLE patients.
• Early recognition and treatment of complications like hyponatremia are vital for patient outcomes.