Irreversible Hemorrhagic Complication of Recurrent Posterior Reversible Encephalopathy Syndrome in a Patient with Systemic Lupus Erythematosus

A diagnosis of posterior reversible encephalopathy syndrome (PRES) is based on a combination of clinical symptoms including headache, altered alertness, abnormalities of visual perception, and seizure, and characteristic neuroimaging findings of transient white matter edema, mostly in the posterior parietal-temporaloccipital regions of the brain (1, 2). Conditions commonly associated with PRES include severe hypertension, eclampsia/ preeclampsia, immunosuppressive medications including cyclosporine and taclorimus, antineoplastic agents, and various cause of renal failure (3, 4). PRES as a complication of systemic lupus erythematosus (PRES-SLE) is not uncommon and neurologic or psychiatric abnormalities occur in up to two-thirds of patients with SLE (4). Usually PRES is reversible vasogenic edema in the posterior circuation territories, although atypical findings such as conversion to irreversible cytotoxic edema, hemorrhage, and enhancement have been described (3). And cytotoxic edema surrounded by extensive vasogenic edema resulted in poor outcome. We report a case of PRESSLE showing irreversible hemorrhagic transformation as a complication of recurrent PRES.