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379 Posterior reversible encephalopathy syndrome in acute post-streptococcal glomerulonephritis
  1. Nurhidayah Zulkifli,
  2. Siew Sing Chua,
  3. Lay Chin Tan,
  4. Fong Chiao Lai,
  5. Noraini Ab Rahman,
  6. Chin Hong Ding
  1. Malaysia


Background Acute post streptococcal glomerulonephritis (PSGN) is well known sequel of group A β-hemolytic streptococcus infections and may be complicated with hypertensive encephalopathy followed by Posterior reversible encephalopathy syndrome (PRES). PRES is also known as acute hypertension encephalopathy, usually present with seizures, hypertension, headache, encephalopathy and/or visual disturbance. The pathophysiology behind PRES is poorly understood. It is usually associated with hypertensive encephalopathy, kidney disease, autoimmune disease, immunosuppressive drug and organ transplantation. Contrast-enhanced computed tomography imaging allows for fast assessment which shows features of edema of the posterior cerebral hemisphere, especially at the parieto-occipital region. PRES can be a presenting sign of PSGN and vice versa.

Objectives To study relationship between PSGN and PRES

Methods Two case reports PSGN with PRES, based on contrast-enhanced computed tomography (CECT) brain.

Results We reported two cases of PSGN with PRES.

First case is a 11 years old boy, who presented with status epilepticus, following one-day history of headache and vomiting. He was afebrile, no history of epilepsy or recent trauma and any drug intake. He had history of left facial cellulitis secondary to odontogenic infection one-week prior the onset of seizure. He was initially diagnosed with PRES after CECT brain.

Second case is a 6 years old boy, who presented with multiple infected impetigo lesions over bilateral lower limb, fever and vomiting. He also developed blurry vision and recurrent vomiting, requiring ICU care due to hypertensive crisis. CECT brain was performed and reported as PRES.

Similarly, both children had persistent microscopic hematuria and hypertension, and investigations show low C3 and normal C4 levels with raised Anti-streptolysin O titer (ASOT), fulfilling the criteria of PSGN.

Conclusions The incidence of PRES is rare in children, but should always be a diagnosis to be considered in children with PSGN presenting with hypertensive crisis and/or rapidly progressive neurological manifestations, e.g. status epilepticus. Early recognition and prompt treatment are important measures in reducing morbidity and mortality.

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