Resistant hypertension and PRES syndrome induced by carbamazepine in a patient with SLE: A case report and literature review

INTRODUCTION: Several conditions of resistant hypertension (RHTN) have been suggested and are often associated in the same patient. Approximately 75% of patients with posterior reversible encephalopathy syndrome (PRES) have moderate to severe HTN at presentation. CASE PRESENTATION: A 26- year old SLE-patient presented with seizures followed by confusion and cortical blindness, in the context of emergent HTN and MRI revealed PRES syndrome. However, antihypertensive drugs were increased to maximum doses with two HD sessions, the patient still had high measures of BP. The dilemma was to find the underlying cause of long-term RHTN in this patient, where several etiologies were implicated. We review the status in more specific details and draw a timeline, which showed constant exposer to carbamazepine from the beginning of HTN. Thereafter, converting the patient to levetiracetam resulted in resolving the RHTN. DISCUSSION/CONCLUSION: We discuss this case with a literature review over the past ten years, which shows only three patients with a neurologic deficit in the context of severe HTN induced by carbamazepine. In the end, determining the secondary etiology of RHTN, in this patient, is considered a diagnosis of challenge due to the coincidence with SLE and the rarity of this side effect of carbamazepine. This is considered a valuable message to always exclude all secondary causes, especially drugs effects, in ESRD-patients with multiple comorbidities.