Posterior reversible encephalopathy syndrome in HIV patients: case report and review of the literature

The cause of posterior reversible encephalopathy syndrome (PRES) is often multifactorial. It is uncommon in patients with human immunodeficiency virus (HIV) infection. However, if the cause of PRES is left untreated it can cause significant morbidity and mortality. Thus, we believe it should be included as a differential in immunosuppressed patients presenting with neurological signs. This case report describes such a patient with acquired immunodeficiency syndrome (AIDS) who developed hypocalcaemia secondary to disseminated histoplasmosis.

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“…[1][2][3][4][5][6] Hypercalcaemia has been associated with PRES in patients with HIV: an adult with MAI 5 and a child with advanced HIV. 2…”

Section: Introductionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome in disseminated histoplasmosis and advanced HIV infection

Stevenson

Taylor

2014

Int J STD AIDS

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“…In most obstetric cases, there is a history of pre-eclampsia and, unlike in the case reported here, PRES usually develops only after delivery [5]. It has also been described in normotensive patients in association with drug-induced [4] or HIV-associated [6] immunosuppression, with thrombotic thrombocytopenic purpura ⁄ haemolytic uraemic syndrome [7,8], and with acute intermittent porphyria [9].…”

Section: Discussionmentioning

confidence: 93%

Posterior reversible encephalopathy syndrome: a report of a case with atypical features

Pratap¹,

Down

2008

Anaesthesia

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SummaryWe report a case of a young woman presenting with profound depression of consciousness and intra-uterine death in the late stages of an unbooked pregnancy. She proceeded to develop features of cardiovascular, renal, hepatic and haematological failures. The patient was challenging to manage in view of uncertainty regarding the underlying cause, and required multidisciplinary consultation. A diagnosis was subsequently made of posterior reversible encephalopathy syndrome in the context of pre-eclampsia. We review the typical presentation and wide-ranging associations of this recently described clinico-neuroradiological syndrome, and look at how appropriate management may lead to rapid resolution of its often life-threatening features. We highlight the importance to anaesthetists and critical care physicians of recognising even atypical cases such as this one in view of key differences in management from similarly presenting conditions. Posterior reversible encephalopathy syndrome (PRES) presents with a variety of neurological features which, although devastating, are potentially reversible on prompt recognition and institution of appropriate treatment [1], but clinicians often fail to suspect it [2]. Delayed diagnosis is frequent and can lead to long-term neurological disability. We describe a case presenting as coma and intra-uterine death in the late stages of an unbooked pregnancy. This patient was challenging to manage in view of uncertainty regarding the diagnosis and particularly serious features, and required consultation and co-ordination between obstetricians, anaesthetists, intensive care physicians, radiologists, neurosurgeons and neurologists. Case reportA 20-year-old woman was brought to a maternity hospital by ambulance having been found unconscious by her flatmates. On arrival, she was unable to maintain her own airway. An oral airway was inserted. Her respiration was laboured with a rate of 10 breaths.min . The blood pressure was 220 ⁄ 120 mmHg. Capillary refill time measured over the sternum was prolonged at 5 s. There was marked generalised oedema. The Glasgow Coma Score was 4 out of 15 (Motor 1, Eyes 1, Verbal 2). Her pupils were 5 mm in diameter, equal, and reactive. Normal tone and tendon jerk reflexes were present in both upper and lower limbs. Inspection of the abdomen revealed a third trimester pregnancy (of which her friends were unaware), and contractions of early labour. Marks on her thigh were consistent with several hours lying on the floor. Vaginal examination showed that the cervix was dilated to 2 cm with fresh meconium draining. Core temperature was elevated at 38.5°C.Initial arterial blood gas analysis showed pH 7.21, P a CO 2 6.9 kPa, P a O 2 37.0 kPa and standard base excess )6.5 mmol.l . Ultrasonography revealed a fetus with no heartbeat. Urinalysis showed ‡ 20 g.dl )1 proteinuria. A working diagnosis was made of severe preeclampsia or eclampsia with an unwitnessed seizure. Possible aetiologies of the ongoing coma were considered

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“…HIV virus has been shown to induce endothelial cell apoptosis, tight junction disruption, oxidative stress, and the expression of pro-inflammatory cytokines and adhesion molecules which stimulate endothelial cell inflammation, all of which culminates in BBB dysfunction [11,16,17]. Most reported cases of PRES occurred in patients with low CD4 counts (range 16–284 cells/ μ l) [9,13,18–21], however, HIV-induced pathology has not been shown to be related to viral load [22]. …”

Section: Discussionmentioning

confidence: 99%

An atypical subacute presentation of posterior reversible encephalopathy syndrome

Bazuaye-Ekwuyasi

Chow

Schmalzle

2017

Journal of Community Hospital Internal Medicine Perspectives

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Posterior reversible encephalopathy syndrome (PRES) characteristically presents with rapid onset of headache, seizure, encephalopathy, and visual changes, along with evidence of parieto-occipital vasogenic edema on magnetic resonance imaging. We describe the case of a 41-year-old female with a protracted presentation of two of the four classic PRES symptoms, which were not immediately recognized as PRES due to the presence of multiple other comorbidities and reasons for encephalopathy. This case highlights the possibility of atypical presentations of PRES and the diagnostic challenges in making this clinical diagnosis when competing diagnoses are present.

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Posterior reversible encephalopathy syndrome in HIV patients: case report and review of the literature

Cited by 14 publications

References 6 publications

Posterior reversible encephalopathy syndrome in disseminated histoplasmosis and advanced HIV infection

Posterior reversible encephalopathy syndrome in disseminated histoplasmosis and advanced HIV infection

Posterior reversible encephalopathy syndrome: a report of a case with atypical features

An atypical subacute presentation of posterior reversible encephalopathy syndrome

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