Henoch-Schönlein purpura nephritis complicated by reversible posterior leukoencephalopathy syndrome

We report a young female patient with Henoch-Schönlein purpura (HSP) nephritis complicated by reversible posterior leukoencephalopathy syndrome (RPLS). The patient suddenly showed generalized seizures and cortical blindness with severe hypertension due to renal insufficiency approximately 1 year aft...

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Bibliographic Details
Published in:Clinical rheumatology 2007-10, Vol.26 (10), p.1761-1763
Main Authors: Sasayama, Daimei, Shimojima, Yasuhiro, Gono, Takahisa, Kaneko, Kazuma, Matsuda, Masayuki, Ikeda, Shu-ichi
Format: Article
Language:English
Subjects:
Adolescent
Brain - pathology
Central Nervous System Diseases - complications
Drug therapy
Female
Humans
Hypertension
Hypertension - diagnosis
Hypertension - therapy
Hypertensive Encephalopathy - complications
Hypertensive Encephalopathy - diagnosis
Magnetic Resonance Imaging - methods
Nephritis - complications
Nephritis - diagnosis
Patients
Purpura, Schoenlein-Henoch - complications
Purpura, Schoenlein-Henoch - diagnosis
Seizures
Tomography, X-Ray Computed - methods
Treatment Outcome
Vasculitis
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Summary:We report a young female patient with Henoch-Schönlein purpura (HSP) nephritis complicated by reversible posterior leukoencephalopathy syndrome (RPLS). The patient suddenly showed generalized seizures and cortical blindness with severe hypertension due to renal insufficiency approximately 1 year after cessation of corticosteroid treatment for HSP nephritis. Magnetic resonance imaging (MRI) demonstrated bilateral abnormal signals mainly in the cerebellum and white matter of the occipital lobe. Clinical symptoms quickly improved in conjunction with disappearance of abnormal signals on brain MRI after starting control of hypertension and continuous hemodiafiltration with steroid pulse therapy and plasmapheresis. RPLS may be caused by vasculitis and also by hemodynamic change due to severe hypertension in HSP, particularly in patients with nephropathy. In such cases intensive treatment should be performed as soon as possible to avoid neurological sequelae.
ISSN:0770-3198
1434-9949
DOI:10.1007/s10067-006-0502-0