Posterior reversible encephalopathy syndrome (PRES) induced by cyclosporine use in a patient with collapsing focal glomeruloesclerosis.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is characterized by abnormalities in cerebral white matter and neurologic symptoms. It can be caused by immunosuppressive drugs or autoimmune diseases. We describe a case of PRES in a patient with collapsing focal glomeruloesclerosis (collapsing FGS) with complete recovery after withdrawal of cyclosporine (CSA).

CASE REPORT: A 27-year-old male presented a corticosteroid-resistant nephrotic syndrome secondary to collapsing FGS corticosteroid. Treatment with CSA was started after a nonresponding course of prednisone. Three weeks later, he developed an abrupt elevation of blood pressure (210/120 mmHg), with headaches, mental confusion, and generalized seizures. Magnetic resonance imaging (MRI) showed lesions suggestive of PRES. CSA was withdrawn, and a new MRI was normal after 2 months.

CONCLUSIONS: PRES is a rare syndrome that must be suspected in every patient presenting neurologic symptoms in the course of immunosuppression. It can be induced by CSA and is totally reversible when the drug is rapidly withdrawn.