Posterior Reversible Encephalopathy Syndrome Potentially Associated With Erythropoietin Analogs: A Case Report

Posterior reversible encephalopathy syndrome (PRES) is a potentially life-threatening but reversible neurological disorder. Commonly seen in the intensive care unit (ICU), PRES can arise from uncontrolled hypertension, renal failure, or the use of immunosuppressants and cytotoxic drugs. Erythropoietin (EPO) analogs help manage anemia in chronic kidney disease, but their hypertensive effects may lead to PRES. We report a patient with end-stage renal disease presenting with PRES that occurred four months after commencing darbepoetin alfa and closely correlated with darbepoetin use. Brain MRI confirmed the diagnosis. Discontinuing the drug and managing blood pressure (BP) resulted in complete neurological recovery. Re-challenging the patient upon recurrence strengthened the causal link. Therefore, we emphasize that healthcare providers should maintain a high index of suspicion for PRES related to EPO in patients in the ICU with hypertension who develop neurological symptoms.