Anti-glomerular basement membrane disease complicated with posterior reversible encephalopathy syndrome and subcortical cerebral hemorrhage: a case report and review of the literature

Abstract

A 71-year-old woman was hospitalized for the treatment of fatigue, fever, and cough. On admission, she showed increased serum inflammation markers, severe anemia, pulmonary hemorrhage, and advanced acute kidney injury requiring hemodialysis. Her serum anti-glomerular basement membrane (GBM) antibody titer was found to be extremely high on the 7th hospital day. She was eventually diagnosed with anti-GBM disease. She was treated with a combination of corticosteroid pulse therapy, oral prednisolone and cyclophosphamide, and plasma exchange, but continued to require maintenance hemodialysis for end-stage kidney disease. During her treatment, she suddenly developed headache, blindness, seizure, and consciousness disturbance. She was diagnosed by magnetic resonance imaging with posterior reversible encephalopathy syndrome (PRES) with subcortical cerebral hemorrhage. Both the PRES and cerebral hemorrhage subsided soon after control of her hypertension and reinforcement of immunosuppressive treatment. PRES, particularly when accompanied by cerebral hemorrhage, may cause irreversible and lethal neurological abnormalities, and nephrologists should, therefore, be aware of the potential risk of PRES in patients with anti-GBM disease. We discuss the current case in the light of the previous literature.

Antiglomerular basement membrane antibody type rapidly progressive glomerulonephritis with seizures: Two cases and literature review

“…Notably, the neurological abnormalities caused by PRES are occasionally irreversible and lethal, especially in patients who develop brain hemorrhage and status epilepticus It is known that there are several case reports of PRES occurring during the course of anti-GBM disease. 11,21 The frequency of such reports in anti-GBM disease is higher compared to other diseases that also lead to acute renal failure. 20 Particularly, Taniguchi and Hanaoka have proposed a new hypothesis regarding the immunological mechanism by which anti-GBM disease can result in PRES.…”

“…It is known that there are several case reports of PRES occurring during the course of anti‐GBM disease 11,21 . The frequency of such reports in anti‐GBM disease is higher compared to other diseases that also lead to acute renal failure 20 .…”

“…This is reflected by the neuroimaging findings, which most often show symmetric reversible T2 high‐signal intensities in the occipital and parietal lobes detected by magnetic resonance imaging (MRI) 10 . An important proportion of patients with PRES present with anti‐GBM disease, and its complications, as their sole risk factors 11–13 …”

“…10 An important proportion of patients with PRES present with anti-GBM disease, and its complications, as their sole risk factors. [11][12][13] Here, we report two cases of anti-GBM disease with rapidly progressive glomerulonephritis (RPGN) and alveolar hemorrhage, with PRES and subcortical cerebral hemorrhage occurred during the treatment of anti-GBM disease. Recent research has proposed a new hypothesis regarding the immunological mechanism by which anti-GBM disease can result in PRES.…”

“… 10 An important proportion of patients with PRES present with anti‐GBM disease, and its complications, as their sole risk factors. 11 , 12 , 13 …”