Posterior reversible encephalopathy syndrome in a renal transplanted patient

Patient: Male, 28 Final Diagnosis: Posterior reversible encephalopathy syndrome Symptoms: Headache • pain around umblical region • seizures • visual disturbances Medication: Mycophenolate mofetil Clinical Procedure: Treatment of parasitosis • antiepileptic treatment • control of hypertension • changing mycophenolate mofetil to everolimus Specialty: Transplantology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible neurological findings with clinical hallmarks such as headache, confusion, seizures, cortical visual disturbances, and other focal neurological signs. CASE REPORT: A 28-year-old male patient was hospitalized secondary to diarrhea and abdominal pain. He had renal transplantation due to renal amyloidosis secondary to familial Mediterranean fever (FMF). In his clinical follow-up, he had seizures, hemiparesis, blurred vision, and vomited an Ascaris lumbricoides. MRI results led to diagnosis of PRES. Mycophenolate mofetil was changed to everolimus, his systolic blood was pressure kept below 140 mm hg, and his intestinal parasitosis was treated. During follow-up, he had no pain and no diarrhea. His neurological symptoms turned to normal within 48 hours and neuroradiological findings returned to normal within 2 weeks. CONCLUSIONS: PRES is a rare disorder of unknown incidence in renal transplantation patients. Early diagnosis is very important to prevent irreversible neurological sequelae. PRES is totally reversible with cessation of the offending agent, rapid control of hypertension, and treatment of the underlying disease. For early diagnosis and to reduce morbidity and mortality, stool sample examination should be made in patients taking immunosuppressive drugs.