Posterior Reversible Encephalopathy Syndrome Associated With Post-Streptococcal Glomerulonephritis in a Young Adult:...

BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological disorder characterized by seizures, headache, visual problems, and vasogenic edema visible on imaging scans. While it is most frequently linked to hypertensive crises, eclampsia, autoimmune conditions, and immunosuppressive drugs, its association with post-streptococcal glomerulonephritis (PSGN) is rare, particularly in adults. Typically, PRES associated with PSGN occurs in children and can develop even when blood pressure is mildly elevated. CASE REPORT We describe the case of a 20-year-old Sudanese man who presented with a sudden, severe headache, 2 episodes of generalized tonic-clonic seizures, and complete painless bilateral vision loss. Examination showed mild hypertension, periorbital swelling, and pedal edema. Laboratory tests indicated acute kidney injury, nephritic-range proteinuria, microscopic hematuria, low complement C3, and markedly elevated anti-streptolysin (ASO) titers, supporting a diagnosis of PSGN. Brain imaging revealed bilateral parieto-occipital vasogenic edema consistent with PRES. The patient was treated with oral antihypertensives, anticonvulsants, and a short course of steroids. Clinical improvement occurred within 24 h, with progressive vision restoration by day 3 and full recovery by day 5. Renal function normalized within 2 weeks, and no neurological deficits remained. CONCLUSIONS This case highlights an uncommon presentation of PRES secondary to PSGN in a young adult with mild-to-moderate blood pressure elevation. It emphasizes the importance of early recognition of PRES in patients with recent streptococcal infection and kidney dysfunction, even if they do not have severe hypertension. Rapid diagnosis and prompt treatment are crucial to achieve full neurological recovery and prevent potential complications.