Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare but severe complication
of acute poststreptococcal glomerulonephritis (APSGN) in children. A 13-year old boy
was diagnosed with APSGN based on clinical, laboratory, and renal biopsy findings.
On the third hospital day, his blood pressure (BP) was 130/80 mm Hg on antihypertensive
and diuretic treatment. He then developed confusion, blurry vision, and changes in
speech and behavior. Over the next few hours, his BP increased to 160/90 to 170/90 mm
Hg (99th percentile, 135/90 mm Hg). Magnetic resonance imaging of the brain revealed
prominent hyperintensities in the right temporal, right temporo-occipital, and right
parieto-occipital gray, and white matter on T2-weighted and fluid-attenuated inversion
recovery images, compatible with PRES (posterior reversible encephalopathy syndrome).
Electroencephalography showed generalized epileptiform activity. After treatment with
anticonvulsant and additional antihypertensive medications, his clinical symptoms
and neuroimaging findings were resolved. Posterior reversible encephalopathy syndrome
should be considered in the differential diagnosis of patients with APSGN developing
sudden neurological symptoms without severe increases in BP.
Keywords
acute poststreptococcal glomerulonephritis - adolescent - posterior reversible encephalopathy
syndrome