J Korean Rheum Assoc.  2007 Sep;14(3):291-296. 10.4078/jkra.2007.14.3.291.

Reversible Posterior Leukoencephalopathy Syndrome in a Patient withSystemic Lupus Erythematosus Treated with Cyclosporine

Affiliations
  • 1Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea. gunwoo@fatima.or.kr
  • 2Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

Abstract

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, seizure, altered mental status and visual impairment. Neuroimaging shows reversible white matter edema predominantly in the parietal and occipital lobes. RPLS has been associated with a variety of conditions, including hypertensive encephalopathy, renal failure, immunosupressive therapy, and autoimmune diseases such as systemic lupus erythematosus (SLE). We report a young woman of SLE presented with headache, generalized tonic-clonic seizure and altered mental status, after taking azathioprine and cyclosporine. The brain magnetic resonance images showed bilateral hyperintensitiy in the posterior parietal, occipital, temporal lobes and cerebellum on T2-weighted images and fluid attenuated inversion recovery images, whereas diffusion-weighted images showed isointensity in the same distribution. The patient was improved clinically and radiologically one week after the control of hypertension and discontinuation of cyclosporine.

Keyword

Reversible posterior leukoencephalopathy syndrome; Systemic lupus erythematosus; Cyclosporine

MeSH Terms

Autoimmune Diseases
Azathioprine
Brain
Cerebellum
Cyclosporine*
Edema
Female
Headache
Humans
Hypertension
Hypertensive Encephalopathy
Lupus Erythematosus, Systemic
Neuroimaging
Occipital Lobe
Posterior Leukoencephalopathy Syndrome*
Rabeprazole
Renal Insufficiency
Seizures
Temporal Lobe
Vision Disorders
Azathioprine
Cyclosporine

Figure

  • Fig. 1. At admission, axial T2-weighted image, (A) showed bilaterally high signal intensity in the occipital and temporal lobes, and coronal FLAIR image, (B) showed high signal intensity in the cerebellum, parietal and temporal lobes of both side. Axial diffusion-weighted images, (C,D) showed isointensity in the cerebellum, occipital and temporal lobes. One week later, axial T2-weighted image, (E) and coronal FLAIR image, (F) showed almost complete resolution of previous lesions.


Cited by  1 articles

Posterior Reversible Encephalopathy Syndrome in a Patient with Lupus Nephritis
Hyun Kyung Kim, Hyoun Ah Kim, Eun Jung Jang, Chang Hee Suh
J Korean Rheum Assoc. 2010;17(2):177-182.    doi: 10.4078/jkra.2010.17.2.177.


Reference

1). Hanly JG., McCurdy G., Fougere L., Douglas JA., Thompson K. Neuropsychiatric events in systemic lupus erythematosus: attribution and clinical significance. J Rheumatol. 2004. 31:2156–62.
2). Brey RL., Holliday SL., Saklad AR., Navarrete MG., Hermosillo-Romo D., Stallworth CL, et al. Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology. 2002. 58:1214–20.
3). Hinchey J., Chaves C., Appignani B., Breen J., Pao L., Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996. 334:494–500.
Article
4). Shin KC., Choi HJ., Bae YD., Lee JC., Lee EB., Song YW. Reversible posterior leukoencephalopathy syndrome in systemic lupus erythematosus with thrombo-cytopenia treated with cyclosporine. J Clin Rheumatol. 2005. 11:164–6.
Article
5). Foocharoen C., Tiamkao S., Srinakarin J., Chamadol N., Sawanyawisuth K. Reversible posterior leukoencephalopathy caused by azathioprine in systemic lupus erythematosus. J Med Assoc Thai. 2006. 89:1029–32.
6). Magnano MD., Bush TM., Herrera I., Altman RD. Reversible posterior leukoencephalopathy in patients with systemic lupus erythematosus. Semin Arthritis Rhem. 2006. 35:396–402.
Article
7). Min L., Zwerling J., ᄋcava LC., Chen IH., Putterman C. Reversible posterior leukoencephalopathy in connective tissue diseases. Semin Arthritis Rhem. 2006. 35:385–95.
Article
8). 박민찬: 박용범: 문재연: 김형종: 이수곤: 허경등. Reversible posterior leukoencephalopathy syndrome과동반된전신성홍반성루푸스1예. 대한류마티스학회지2002;9; 335-40.
9). Primavera A., Audenino D., Mavilio N., Cocito L. Reversible posterior leucoencephalopathy syndrome in systemic lupus and vasculitis. Ann Rhem Dis. 2001. 60:534–7.
Article
10). Thaipisuttikul I., Phanthumchinda K. Recurrent reversible posterior leukoencephalopathy in a patient with systemic lupus erythematosus. J Neurol. 2005. 252:230–1.
Article
11). Yong PFK., Hamour SMA., Burns A. Reversible posterior leukoencephalopathy in a patient with systemic sclerosis/systemic lupus erythematosus overlap syndrome. Nephrol Dial Transplant. 2003. 18:2660–2.
Article
12). Garg RK. Posterior leukoencephalopathy syndrome. Postgrad Med J. 2001. 77:24–8.
Article
13). Ay H., Buonanno FS., Schaefer PW., Le DA., Wang B., Gonzalez RG, et al. Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology. 1998. 51:1369–76.
Article
14). Schwartz RB., Jones KM., Kalina P., Bajakian RL., Mantello MT., Garada B, et al. Hypertensive encephalopathy: findings on CT, MRI imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992. 159:379–83.
15). Sheth RD., Riggs JE., Bodenstenier JB., Gutierrez AR., Ketonen LM., Ortiz ᄋA. Parietal occipital edema in hypertensive encephalopathy: a pathogenic mechanism. Eur Neurol. 1996. 36:25–8.
Article
Full Text Links
  • JKRA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr