Posterior reversible encephalopathy syndrome in a child with leptospira-associated glomerulonephritis: the 3 P'S...

Area of Science:

• Neurology
• Pediatrics
• Infectious Diseases

Background:

• Posterior reversible encephalopathy syndrome (PRES) is an under-recognized cause of pediatric seizures.
• PRES is often misdiagnosed, particularly when co-occurring with infections.

Purpose of the Study:

• To report a case of PRES secondary to leptospira-associated glomerulonephritis in a child.
• To highlight the diagnostic challenge posed by anchoring bias in PRES.
• To introduce a practical framework for early PRES recognition and management.

Main Methods:

• Case report of a middle childhood girl with recurrent seizures after fever and flood exposure.
• Diagnostic workup included serology, blood pressure monitoring, and CT brain imaging.
• Treatment involved antihypertensives, antiepileptics, and antibiotics.

Main Results:

• Initial diagnosis was leptospira encephalitis, but progressive hypertension and CT findings confirmed PRES.
• PRES was secondary to leptospira-associated acute glomerulonephritis.
• The patient improved with treatment and was discharged seizure-free.

Conclusions:

• Leptospira infection can precipitate PRES via acute glomerulonephritis.
• Anchoring bias can delay PRES diagnosis.
• The '3 P's' (Pressure, Pattern, Pictures) framework can improve PRES recognition and management in children.