Treatment of Posterior Reversible Encephalopathy Syndrome that Occurred in a Patient with Systemic Lupus Erythematosus by Plasmapheresis

Abstract

Posterior reversible encephalopathy syndrome is characterized by visual and mental disturbances, nausea and vomiting and generalized or focal convulsions and often represents itself with parietal and occipital oedema formation. We want to report the treatment of posterior reversible encephalopathy syndrome with plasmapheresis, which developed in a 35-year-old woman with systemic lupus erythematosus diagnosed by renal biopsy 3 years ago. She has been followed up in the intensive care unit three times. However, she had been transferred to the nephrology department of our university hospital because of her uncontrolled blood pressure. Oral antihypertensive therapy, corticosteroid 500 mg 1 × 1 and cyclophosphamide were started for the activation of lupus. After the detection of low complement levels, systemic lupus erythematosus activation was suspected. She developed mental deterioration after her first plasmapheresis treatment and was then consulted by the neurology and intensive care unit doctors. Diffusion cranial magnetic resonance imaging was found compatible with posterior reversible encephalopathy syndrome. The patient was transferred to our intensive care unit. The patient gained consciousness after her second plasmapheresis. After 5 days of follow-up in our intensive care unit and after significant regression was observed in the magnetic resonance imaging analysis, the patient was transferred to the nephrology service conscious, cooperated and orientated. At the nephrology service, after a total of 13 times of plasmapheresis, complement levels were increased and she was discharged with corticosteroid therapy. Posterior reversible encephalopathy syndrome can be observed in patients with systemic lupus erythematosus and intensive care unit treatment may be required. To control the hypertension, plasmapheresis should be kept in mind in addition to the multiple antihypertensive therapy in these patients.Keywords: Systemic lupus erythematosus, posterior reversible encephalopathy syndrome, plasmapheresis, intensive care unit Posterior reversible ensefalopati sendromu, bulantı-kusma, görsel ve mental değişiklikler, jeneralize veya fokal nöbetler ile karakterize olan ve genellikle kendini pariyetal ve oksipital bölgede yaygın ödem formasyonu ile kendini gösterir. Otuz beş yaşında 3 yıl önce böbrek biyopsisi ile sistemik lupus eritematozus tanısı konulan kadın hastada gelişen posterior reversibl ensefalpati olgusunun plazmaferezle tedavisini rapor etmek istedik. Hasta 3 kez yoğun bakımda takip edilmişti. Ancak kontrolsüz kan basıncı nedeniyle üniversitemiz nefroloji servisine sevk edilmişti. Hastaya lupus aktivasyonuna yönelik antihipertansif tedavi, kortikosteroid 1 x 500 mg ve siklofosfamid başlandı. Hastanın kompleman düzeylerinin düşük tespit edilmesi üzerine lupus aktivasyonundan şüphelenil-di. İlk plazmaferez tedavisi sonrası bilinci bozulan hasta nöroloji ve yoğun bakım doktorları tarafından konsülte edildi. Diffüzyon kraniyal manyetik rezonans görüntülemesi, posterior reversibl ensefalopati ile uyumlu bulun...

Dramatic Response of Lupus Enteritis, Nephritis, and Pancytopenia to Plasmapheresis and Rituximab

“…In several studies, the therapeutic role of plasmapheresis in SLE has been mentioned. The use of plasmapheresis has been proposed for the management of lupus-induced diffuse alveolar hemorrhages, retinal vasculitis [ 10 ], posterior reversible encephalopathy syndrome [ 23 ], refractory TTP [ 24 ], lupus cerebritis [ 25 ], and catastrophic APLA [ 26 ]. However, according to our knowledge, for refractory lupus-induced GI vasculitis, no role of plasmapheresis has been mentioned in the literature.…”