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Case 341: Infratentorial Posterior Reversible Encephalopathy Syndrome Associated with Interferon-β in Relapsing
Nikolaos S Avramiotis1, Matthias A Mutke2, Matthias Mehling1
1Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
Radiology
|September 30, 2025
Summary
This case study details a relapsing multiple sclerosis (RMS) patient experiencing blurry vision and elevated blood pressure while on interferon-beta (INF-β) treatment. Investigations revealed hypertensive retinopathy and active RMS lesions, prompting antihypertensive therapy.
Area of Science:
- Neurology
- Immunology
- Ophthalmology
Background:
- A 36-year-old male with a 13-year history of relapsing multiple sclerosis (RMS) was treated with subcutaneous interferon-beta (INF-β).
- The patient presented with a one-week history of blurry vision and was found to have markedly elevated blood pressure (214/122 mm Hg).
- Previous MRI showed new cerebellar lesions suggestive of active RMS without neurological deficits.
Purpose of the Study:
- To investigate the cause of blurry vision in a patient with RMS on INF-β therapy.
- To evaluate the patient's neurological status, cardiovascular health, and potential treatment side effects.
- To determine the appropriate management strategy for the patient's presenting symptoms and underlying condition.
Main Methods:
- Clinical presentation and history review.
- Physical examination, including neurological and ophthalmologic evaluations (fundoscopy).
- Laboratory analyses including liver enzymes, urinalysis (microalbuminuria), lipid profile, CSF analysis (oligoclonal bands, PCR for pathogens and JC virus).
- Magnetic Resonance Imaging (MRI) of the brain.
Main Results:
- Fundoscopy revealed bilateral hypertensive retinopathy; neurological examination was normal except for saccadic gaze (EDSS 1).
- Laboratory tests showed elevated liver enzymes (likely due to INF-β), microalbuminuria, and hyperlipidemia.
- CSF analysis was positive for oligoclonal bands but negative for meningitis/encephalitis pathogens and JC virus DNA.
- Brain MRI confirmed new cerebellar lesions, and antihypertensive treatment with perindopril and amlodipine was initiated.
Conclusions:
- The patient's symptoms were attributed to a combination of hypertensive retinopathy and active RMS lesions.
- A wait-and-see approach was adopted, avoiding steroids or antimicrobial therapy.
- Management focused on controlling hypertension and monitoring RMS activity.
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