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OP-100 An incidental case of pres with infective endocarditis and acute post-streptococcal glomerulonephritis
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  1. Ilknur Yuvaci,
  2. Esra Dicle Dogan,
  3. Mehtap Kaya
  1. Kartal Dr Lutfi Kirdar City Hospital, Istanbul, Turkey

Abstract

Aim Posterior reversible encephalopathy syndrome (PRES) is a medical condition that is diagnosed based on both clinical symptoms and neuroimaging findings. PRES commonly is associated with various clinical disorders. The primary cause is typically infections, however other factors such as autoimmune, renal, oncological, and hematological illnesses might also contribute. The purpose of this case is to highlight the rare association between PRES with infective endocarditis, acute post-streptococcal glomerulonephritis (APSGN).

Material and Method An 11-year-old boy presented to our emergency department with an episode of seizure which lasted for five minutes. His medical history was unremarkable. At the emergency department, the patient had another episode of seizure which was stopped by midazolam. His chest x-ray revealed bilateral pleural effusion, he was initiated with ceftriaxone and teicoplanin also levetiracetam was given for his seizures. His blood pressure was high and his other vital signs were normal. His EEG was normal; additionally, his MRI report revealed PRES (figure 1). Ophthalmological examination revealed that he had a Roth spot on his eye which was indicative of infective endocarditis. His Echocardiogram report showed that he had left ventricular vegetation and aortic insufficiency. While looking for other causes his full urinalysis showed that he had recurrent hemoglobinuria as well as he was continuing to have high blood pressure. His ASO level was elevated to 920 IU/ml (reference range: <150 IU/ml) and C3 was decreased to 0.38 gr/l (reference range: 0.9–1.8 gr/l).

Abstract OP-100 Figure 1

MRI 1. Brain MRI revealed PRES.

Results As a result, IV antibiotherapy was given for four weeks and his blood pressure was kept under control. A control MRI showed that PRES was resolving. He responded well to the treatment and remained well, no seizure was seen after his treatment.

Conclusions PRES in children is a rare but potentially serious neurological disorder fortunately, long-term outcomes suggest that many children are able to recover or experience only mild residual symptoms.

  • Infective Endocarditis
  • Posterior Reversible Encephalopathy Syndrome
  • Acute Post-Streptococcal Glomerulonephritis
  • Seizure
  • Roth Spot

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