Gastroenterologie
a hepatologie

Posterior Reversible Encephalopathy Syndrome in a child with ulcerative colitis

Eva Karásková¹, Maria Velgáňová-Véghová¹, Miloš Geryk¹, Vratislav Smolka¹, Kamila Michálková², Dagmar Pospíšilová²

+ Affiliation
¹ Dětská klinika LF UP a FN Olomouc
² Radiologická klinika LF UP a FN Olomouc

Summary

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical-neuroradiological entity with acute onset, defined as a vasogenic brain edema associated with neurotoxic impairment. We report the case of an eight-year-old boy with severe ulcerative colitis and celiac disease, who was treated with infliximab and azathioprine. On the 10th day after infliximab administration, a 45-minute unconsciousness developed with generalized convulsions and pupil miosis, accompanied by arterial hypertension. The boy was treated with anticonvulsants and antihypertensives. The state of consciousness improved ad integrum. Magnetic resonance imaging (MRI) of the brain revealed symmetric areas of high-intensity signal involving occipital and fronto-parietal lobes. Lumbar puncture was negative. Repeat MRI, seven days from the onset, showed resolution of the previous changes. The condition was assessed as PRES that developed as a complication of treatment (infliximab, azathioprine) in a patient with active ulcerative colitis. The case indicates a possible risk of developing PRES in patients with uncompensated inflammatory bowel disease, receiving immunosuppressive and/or bio­logical treatment and/or developing arterial hypertension.

Keywords

ulcerative colitis, infliximab, posterior reversible encephalopathy syndrom, azatioprin, children

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users

Literature

1. Gao B, Lyu C, Lerner A et al. Controversy of posterior reversible encephalopathy syndrome: what have we learnt in the last 20 years? J Neurol Neurosurg Psychiatry 2018; 89 (1): 14–20. doi: 10.1136/jnnp-2017-316225.
2. Tetsuka S, Ogawa T. Posterior reversible encephalopathy syndrome: A review with emphasis on neuroimaging characteristics. J Neurol Sci 2019; 404: 72–79. doi: 10.1016/j.jns.2019.07.018.
3. Zamvar V, Sugarman ID, Tawfik RF et al. Posterior reversible encephalopathy syndrome following infliximab infusion. J Pediatr Gastroenterol Nutr 2009; 48 (1): 102–105. doi: 10.1097/MPG.0b013e31818aedb4.
4. Striano P, Striano S, Tortora F et al. Clinical spectrum and critical care management of Posterior Reversible Encephalopathy Syndrome (PRES). Med Sci Monit 2005; 11 (11): CR549–CR553.
5. Shankar J, Banfield J. Posterior reversible encephalopathy syndrome: a review. Can Assoc Radiol J 2017; 68 (2): 147–153. doi: 10.1016/j.carj.2016.08.005.
6. Dvořáková L. PRES syndrom u pacienta s poststreptokokovou Glomerulonefritidou. Pediatr praxi 2013; 14 (3): 183–186.
7. Gavrilovici C, Miron I, Voroneanu L et al. Posterior reversible encephalopathy syndrome in children with kidney disease. Int Urol Nephrol 2017; 49 (10): 1793–1800. doi: 10.1007/s11255-017-1684-x.
8. Ghali MGZ, Davanzo J, Leo M et al. Posterior reversible encephalopathy syndrome in pediatric patients: pathophysiology, dia­gnosis, and management. Leuk Lymphoma 2019; 60 (10): 2365–2372. doi: 10.1080/10428194.2019.1594210.
9. Hinchey J, Chaves C, Appignani B et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334 (8): 494–500. doi: 10.1056/NEJM199602223340803.
10. Lava SAG, Peeters GGAM, Bianchetti MG et al. Posterior reversible encephalopathy syndrome in Henoch-Schönlein purpura. Rheumatol Int 2017; 37 (3): 461–463. doi: 10.1007/ s00296-016-3577-1.
11. Khan SJ, Arshad AA, Fayyaz MB et al. Posterior reversible encephalopathy syndrome in pediatric cancer: clinical and radiologic findings. J Glob Oncol 2018; 4: 1–8. doi: 10.1200/JGO.17.00089.
12. Tambasco N, Mastrodicasa E, Salvatori C et al. Prognostic factors in children with PRES and hematologic diseases. Acta Neurol Scand 2016; 134 (6): 474–483. doi: 10.1111/ane.12570.
13. Yamagishi H, Chen-Yoshikawa TF, Date H. Basiliximab for posterior reversible encephalopathy syndrome after lung transplantation. Eur J Cardiothorac Surg 2017; 52 (4): 823–824. doi: 10.1093/ejcts/ezx151.
14. Cahová P, Bernátková H, Muchová M et al.Posterior Reversible Encephalopathy Syndrom/PRES/u onkologických dětských pacientů –kazuistiky. Cesk Slov Neurol N 2011; 74 (107): S21–S22.
15. Cherian A, Soumya CV, Iype T et al. Posterior reversible encephalopathy syndrome with PLEDs-plus due to mesalamine. J Neurosci Rural Pract 2014; 5 (1): 72–75. doi: 10.4103/ 0976- 147.127882.
16. Kikuchi S, Orii F, Maemoto A et al. Reversible posterior leukoencephalopathy syndrome associated with treatment for acute exacerbation of ulcerative colitis. Intern Med 2016; 55 (5): 473–477.doi: 10.2169/internalmedicine.55.5250.
17. Ogawa R, Oikawa T, Shijo T et al. Case of posterior reversible encephalopathy syndrome due to azathioprine. Rinsho Shinkeigaku 2015; 55 (12): 936–939. doi: 10.5692/clinicalneurol.cn-000733.
18. Nemati R, Mehdizadeh S, Salimipour H et al. Neurological manifestations related to Crohn‘s disease: a boon for the workforce. Gastroenterol Rep (Oxf) 2019; 7 (4): 291–297. doi: 10.1093/gastro/gox034.
19. Haddock R, Garrick V, Horrocks I et al. A case of posterior reversible encephalopathy syndrome in a child with Crohn‘s disease treated with Infliximab. J Crohns Colitis 2011; 5 (6): 623–627. doi: 10.1016/j.crohns.2011.06.011.
20. Mishra A, Seril DN. Posterior reversible encephalopathy syndrome following ustekinumab induction for Crohn‘s disease. Case Rep Gastroenterol 2018; 12 (2): 521–527. doi: 10.1159/000492462.
21. Gratton D, Szapary P, Goyal K et al. Reversible posterior leukoencephalopathy syndrome in a patient treated with ustekinumab: case report and review of the literature. Arch Dermatol 2011; 147 (10): 1197–1202. doi: 10.1001// archdermatol.2011.161.