Infection-provoked Reversible Posterior Leukoencephalopathy Syndrome in Children Experiencing Nephrotic Syndrome: A Case Report
Journal of Pediatric Nephrology,
Vol. 12 No. 1 (2024),
10 April 2025
https://doi.org/10.22037/jpn.v12i1.48532
Abstract
Background and Aim: Reversible posterior leukoencephalopathy syndrome (RPLS), also
known as posterior reversible encephalopathy syndrome (PRES), is an uncommon and varied
cliniconeuroradiological condition that can manifest with a range of clinical symptoms, such
as visual disturbances, altered consciousness, headaches, and seizures. Hypertension and
immunosuppression are two primary factors that increase the likelihood of developing RPLS.
Nevertheless, RPLS can also occur in the presence of other risk factors.
Case Presentation: A 10-year-old Asian boy diagnosed with nephrotic syndrome exhibited
symptoms of seizures and fever. His blood pressure (BP) was within the normal range, and
he received treatment with immunosuppressive medications.
Conclusion: In cases where patients with nephrotic syndrome develop an infection, it is
important to assess for symptoms of RPLS. Timely diagnosis and proper management of
RPLS can help prevent mortality and morbidity.
- posterior reversible encephalopathy syndrome (PRES)
- Nephrotic syndrome
- infection
- Immunosuppressive
How to Cite
References
[1] Ito Y. [Reversible posterior leukoencephalopathy syndrome
(RPLS) (Japanese)]. Nihon Naika Gakkai Zasshi. 2006;
95(7):1297-304. [DOI:10.2169/naika.95.1297] [PMID]
[2] Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical
spectrum of reversible posterior leukoencephalopathy syndrome.
Arch Neurol. 2008; 65(2):205-10. [DOI:10.1001/archneurol.
2007.46] [PMID]
[3] Li KY, Chien CF, Tsai CL, Chen HC, Wu MN, Lai CL, et al.
Infection-provoked reversible posterior leukoencephalopathy
syndrome in an adult with nephrotic syndrome: A case
report. BMC Neurol. 2020; 20(1):349. [DOI:10.1186/s12883-
020-01922-x] [PMID]
[4] Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang
A, et al. A reversible posterior leukoencephalopathy syndrome.
N Engl J Med. 1996; 334(8):494-500. [DOI:10.1056/
NEJM199602223340803] [PMID]
[5] Ito Y, Arahata Y, Goto Y, Hirayama M, Nagamutsu M, Yasuda
T, et al. Cisplatin neurotoxicity presenting as reversible
posterior leukoencephalopathy syndrome. AJNR Am J Neuroradiol.
1998; 19(3):415-7. [PMID]
[6] Zelaya JE, Al-Khoury L. Posterior Reversible Encephalopathy
Syndrome. Treasure Island: StatPearls; 2020. [Link]
[7] Garner O, Ramirez A, Iardino A. A case of posterior reversible
encephalopathy syndrome associated with sepsis. BMJ
Case Rep. 2018; 2018:bcr2018225128. [DOI:10.1136/bcr-2018-
225128] [PMID]
[8] Hobson EV, Craven I, Blank SC. Posterior reversible encephalopathy
syndrome: A truly treatable neurologic illness.
Perit Dial Int. 2012; 32(6):590-4. [DOI:10.3747/pdi.2012.00152]
[PMID]
[9] Chang MY, Tsai BM, Hung SY, Wang HH, Lee YJ, Ho LC, et
al. Posterior reversible encephalopathy syndrome in an adult
with nephrotic syndrome. Nephrology. 2014; 19(8):514-5.
[DOI:10.1111/nep.12275] [PMID]
[10] Akutsu N, Iwashita C, Maruyama M, Ootsuki K, Ito T,
Saigo K, et al. Two cases of calcineurin inhibitor-associated
reversible posterior leukoencephalopathy syndrome in renal
transplant recipients. Transplant Proc. 2008; 40(7):2416-8.
[DOI:10.1016/j.transproceed.2008.07.104] [PMID]
[11] Khurana K, Acharya S, Shukla S, Kumar S, Mishra P,
Mishra Sr P. Chronic glomerulonephritis and malignant hypertension
with PRES (posterior reversible encephalopathy
syndrome) presenting as status epilepticus: A case report.
Cureus. 2023; 15(8):e43902. [DOI:10.7759/cureus.43902]
[12] Marinari A, Bottoni A, Stoppino L, Grilli G, Soldano L,
Calò A, et al. Posterior reversible encephalopathy syndrome
(PRES) in a 6-year-old child with nephrotic syndrome. Radiol
Case Rep. 2020; 16(1):140-4. [DOI:10.1016/j.radcr.2020.10.057]
[PMID]
[13] Ishikura K, Ikeda M, Hamasaki Y, Hataya H, Nishimura G,
Hiramoto R, et al. Nephrotic state as a risk factor for developing
posterior reversible encephalopathy syndrome in paediatric
patients with nephrotic syndrome. Nephrol Dial Transplant.
2008; 23(8):2531-6. [DOI:10.1093/ndt/gfn013] [PMID]
[14] Gewirtz AN, Gao V, Parauda SC, Robbins MS. Posterior reversible
encephalopathy syndrome. Curr Pain Headache Rep.
2021; 25(3):19. [DOI:10.1007/s11916-020-00932-1] [PMID]
[15] Kwon S, Koo J, Lee S. Clinical spectrum of reversible posterior
leukoencephalopathy syndrome. Pediatr Neurol. 2001;
24(5):361-4. [DOI:10.1016/S0887-8994(01)00265-X] [PMID]
[16] Fugate JE, Rabinstein AA. Posterior reversible encephalopathy
syndrome: Clinical and radiological manifestations,
pathophysiology, and outstanding questions. Lancet Neurol.
2015; 14(9):914-25. [DOI:10.1016/S1474-4422(15)00111-8]
[PMID]
[17] Marra A, Vargas M, Striano P, Del Guercio L, Buonanno
P, Servillo G. Posterior reversible encephalopathy syndrome:
The endothelial hypotheses. Med Hypotheses. 2014; 82(5):619-
22. [DOI:10.1016/j.mehy.2014.02.022] [PMID]
[18] Ganesh K, Nair RR, Kurian G, Mathew A, Sreedharan S,
Paul Z. Posterior reversible encephalopathy syndrome in kidney
disease. Kidney Int Rep. 2017; 3(2):502-7. [DOI:10.1016/j.
ekir.2017.10.017] [PMID]
[19] Raj S, Overby P, Erdfarb A, Ushay HM. Posterior reversible
encephalopathy syndrome: Incidence and associated
factors in a pediatric critical care population. Pediatr Neurol.
2013; 49(5):335-9. [DOI:10.1016/j.pediatrneurol.2013.06.007]
[PMID]
[20] Emami E, Alikhani A, Oroojeni A. Recurrent urinary tract
infection in a patient with neurogenic bladder. J Nephropharmacol.
2022; 11(1):1. [Link]
[21] Emami E, Safari S, Javanmard P. Hemolytic uremic syndrome
following COVID-19; a case report. J Renal Inj Prev.
2022; 11(2):e31972. [DOI:10.34172/jrip.2022.31972]
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