Rapid clinical recovery of posterior reversible encephalopathy syndrome in two cases of IgA nephropathy disease and nephrotic syndrome type 9 post-renal transplant

• Published in: Transplant immunology Vol. 68; p. 101450
• Main Authors: El Hage, Said, Akiki, Dany, Khalife, Lourdes, Assaf, Elie, Jaoude, Maroun Abou
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.10.2021
• Subjects: Case report; Encephalopathy; Female; Glomerulonephritis, IGA - diagnosis; Humans; Hypertension; Immunosuppressant; Kidney Transplantation; Nephrotic Syndrome - diagnosis; Posterior Leukoencephalopathy Syndrome - diagnosis; Posterior Leukoencephalopathy Syndrome - etiology; Posterior reversible encephalopathy syndrome; Pregnancy; Renal transplant; CT; Immunosuppressant; Case report; Renal transplant; Posterior reversible encephalopathy syndrome; PRES; MRI; Encephalopathy; BMI
• ISSN: 0966-3274; 1878-5492
• DOI: 10.1016/j.trim.2021.101450

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome often associated with immunosuppressant drug use, renal disease, and eclampsia and characterized by parieto-occipital vasogenic edema that usually resolves within days. Globally and in the settings of renal transplant, literature concerning PRES is very scattered. In this report, we provide two cases, one diagnosed with IgA nephropathy and another with nephrotic syndrome type 9 that developed episodes of tonic-clonic seizure immediately after renal transplant in case 1 and four days post-transplant in case 2. The two patients had a history of hypertension, renal disease, corticosteroid and immunosuppressant drug use. Neuro-imaging showed typical vasogenic edema involving the parieto-occipital areas. Therefore, the clinical-radiological presentation confirmed the diagnosis of PRES in both cases. Also, rapid neurologic recovery was witnessed upon administration of anti-epileptic and anti-hypertensive medications. Non-discontinuation of immunosuppressants, steroids, early symptomatic management, and blood pressure control are favorable factors that might explain the rapid recovery of these two patients. •Posterior reversible encephalopathy syndrome (PRES) affects the parieto-occipital lobes and can occur after renal transplant.•Rapid and complete recovery of transplant-induced PRES was reported among two young cases of middle eastern descent with renal disease.•Antihypertensive and anti-epileptic drugs should be promptly administered after the diagnosis of PRES.•Non-discontinuation of immunosuppressant drugs can possibly lead to rapid PRES recovery by preserving renal graft function.