Article ; Online: Posterior reversible encephalopathy syndrome (PRES) associated with SARS-CoV-2 infection in a patient under maintenance haemodialysis: a case report.
2023 Volume 24, Issue 1, Page(s) 286
Abstract: ... discharged without sequelae.: Conclusions: We report the first case of PRES associated with SARS-CoV-2 ... previous report has yet described PRES associated with SARS-CoV-2 infection among patients undergoing ... SARS-CoV-2 infection possibly be associated with the development of PRES. ...
| Abstract | Background: Endothelial dysfunction is common in patients undergoing chronic haemodialysis, and is a major cause of posterior reversible encephalopathy syndrome (PRES). Recently, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to cause endothelial dysfunction by infecting vascular endothelial cells. Several cases of neurological complications in patients without kidney dysfunction, and only a few cases in patients with chronic kidney disease, have been reported in the literature. However, no previous report has yet described PRES associated with SARS-CoV-2 infection among patients undergoing maintenance dialysis. Case presentation: A 54-year-old woman undergoing maintenance haemodialysis was admitted to our hospital for status epilepticus. She had developed end-stage kidney disease (ESKD) secondary to diabetic nephropathy. Seven days prior to admission, she had developed fever and was diagnosed with COVID-19. Subsequently her blood pressure increased from 160/90 mmHg to 190/100 mmHg. On admission, she presented with severe hypertension (> 220/150 mmHg), unconsciousness, and epilepticus. CT tomography revealed no signs of brain haemorrhage. Cranio-spinal fluid (CSF) examination revealed no signs of encephalitis, and CSF polymerase chain reaction (PCR) for SARS-CoV-2 was negative. MRI findings revealed focal T2/FLAIR hyperintensity in the bilateral parietooccipital regions, leading to the diagnosis of PRES. Deep sedation and strict blood pressure control resulted in a rapid improvement of her symptoms, and she was discharged without sequelae. Conclusions: We report the first case of PRES associated with SARS-CoV-2 infection in a patient undergoing maintenance haemodialysis. Patients undergoing maintenance haemodialysis are at high risk of PRES because of several risk factors. SARS-CoV-2 infection causes direct invasion of endothelial cells by binding to angiotensin-converting enzyme 2 (ACE2), initiating cytokine release, and hypercoagulation, leading to vascular endothelial cell injury and increased vascular leakage. In the present case, SARS-CoV-2 infection possibly be associated with the development of PRES. |
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| MeSH term(s) | Humans ; Female ; Middle Aged ; Posterior Leukoencephalopathy Syndrome/etiology ; Posterior Leukoencephalopathy Syndrome/complications ; COVID-19/complications ; Endothelial Cells ; SARS-CoV-2 ; Renal Dialysis/adverse effects ; Vascular Diseases/complications |
| Language | English |
| Publishing date | 2023-09-29 |
| Publishing country | England |
| Document type | Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 2041348-8 |
| ISSN | 1471-2369 ; 1471-2369 |
| ISSN (online) | 1471-2369 |
| ISSN | 1471-2369 |
| DOI | 10.1186/s12882-023-03319-7 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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