tetano
Editor, Senior Moderator
BMC Nephrol
. 2023 Sep 29;24(1):286.
doi: 10.1186/s12882-023-03319-7. Posterior reversible encephalopathy syndrome (PRES) associated with SARS-CoV-2 infection in a patient under maintenance haemodialysis: a case report
Yuki Shimamoto[SUP] 1 [/SUP], Hirohito Sasaki[SUP] 2 [/SUP], Kenji Kasuno[SUP] 3 [/SUP], Yuki Watanabe[SUP] 1 [/SUP], Sayumi Sakashita[SUP] 1 [/SUP], Sho Nishikawa[SUP] 1 [/SUP], Kazuhisa Nishimori[SUP] 1 [/SUP], Sayu Morita[SUP] 1 [/SUP], Yudai Nishikawa[SUP] 1 [/SUP], Mamiko Kobayashi[SUP] 1 [/SUP], Sachiko Fukushima[SUP] 1 [/SUP], Soichi Enomoto[SUP] 2 [/SUP], Naoki Takahashi[SUP] 1 [/SUP], Tadanori Hamano[SUP] 2 [/SUP], Ippei Sakamaki[SUP] 4 [/SUP], Hiromichi Iwasaki[SUP] 5 [/SUP], Masayuki Iwano[SUP] 1 [/SUP]
Affiliations
Background: Endothelial dysfunction is common in patients undergoing chronic haemodialysis, and is a major cause of posterior reversible encephalopathy syndrome (PRES). Recently, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to cause endothelial dysfunction by infecting vascular endothelial cells. Several cases of neurological complications in patients without kidney dysfunction, and only a few cases in patients with chronic kidney disease, have been reported in the literature. However, no previous report has yet described PRES associated with SARS-CoV-2 infection among patients undergoing maintenance dialysis.
Case presentation: A 54-year-old woman undergoing maintenance haemodialysis was admitted to our hospital for status epilepticus. She had developed end-stage kidney disease (ESKD) secondary to diabetic nephropathy. Seven days prior to admission, she had developed fever and was diagnosed with COVID-19. Subsequently her blood pressure increased from 160/90 mmHg to 190/100 mmHg. On admission, she presented with severe hypertension (> 220/150 mmHg), unconsciousness, and epilepticus. CT tomography revealed no signs of brain haemorrhage. Cranio-spinal fluid (CSF) examination revealed no signs of encephalitis, and CSF polymerase chain reaction (PCR) for SARS-CoV-2 was negative. MRI findings revealed focal T2/FLAIR hyperintensity in the bilateral parietooccipital regions, leading to the diagnosis of PRES. Deep sedation and strict blood pressure control resulted in a rapid improvement of her symptoms, and she was discharged without sequelae.
Conclusions: We report the first case of PRES associated with SARS-CoV-2 infection in a patient undergoing maintenance haemodialysis. Patients undergoing maintenance haemodialysis are at high risk of PRES because of several risk factors. SARS-CoV-2 infection causes direct invasion of endothelial cells by binding to angiotensin-converting enzyme 2 (ACE2), initiating cytokine release, and hypercoagulation, leading to vascular endothelial cell injury and increased vascular leakage. In the present case, SARS-CoV-2 infection possibly be associated with the development of PRES.
Keywords: End-stage kidney disease; Haemodialysis; Intravascular endothelial cell injury; Posterior reversible encephalopathy syndrome; Status epilepticus.
. 2023 Sep 29;24(1):286.
doi: 10.1186/s12882-023-03319-7. Posterior reversible encephalopathy syndrome (PRES) associated with SARS-CoV-2 infection in a patient under maintenance haemodialysis: a case report
Yuki Shimamoto[SUP] 1 [/SUP], Hirohito Sasaki[SUP] 2 [/SUP], Kenji Kasuno[SUP] 3 [/SUP], Yuki Watanabe[SUP] 1 [/SUP], Sayumi Sakashita[SUP] 1 [/SUP], Sho Nishikawa[SUP] 1 [/SUP], Kazuhisa Nishimori[SUP] 1 [/SUP], Sayu Morita[SUP] 1 [/SUP], Yudai Nishikawa[SUP] 1 [/SUP], Mamiko Kobayashi[SUP] 1 [/SUP], Sachiko Fukushima[SUP] 1 [/SUP], Soichi Enomoto[SUP] 2 [/SUP], Naoki Takahashi[SUP] 1 [/SUP], Tadanori Hamano[SUP] 2 [/SUP], Ippei Sakamaki[SUP] 4 [/SUP], Hiromichi Iwasaki[SUP] 5 [/SUP], Masayuki Iwano[SUP] 1 [/SUP]
Affiliations
- PMID: 37773103
- DOI: 10.1186/s12882-023-03319-7
Background: Endothelial dysfunction is common in patients undergoing chronic haemodialysis, and is a major cause of posterior reversible encephalopathy syndrome (PRES). Recently, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to cause endothelial dysfunction by infecting vascular endothelial cells. Several cases of neurological complications in patients without kidney dysfunction, and only a few cases in patients with chronic kidney disease, have been reported in the literature. However, no previous report has yet described PRES associated with SARS-CoV-2 infection among patients undergoing maintenance dialysis.
Case presentation: A 54-year-old woman undergoing maintenance haemodialysis was admitted to our hospital for status epilepticus. She had developed end-stage kidney disease (ESKD) secondary to diabetic nephropathy. Seven days prior to admission, she had developed fever and was diagnosed with COVID-19. Subsequently her blood pressure increased from 160/90 mmHg to 190/100 mmHg. On admission, she presented with severe hypertension (> 220/150 mmHg), unconsciousness, and epilepticus. CT tomography revealed no signs of brain haemorrhage. Cranio-spinal fluid (CSF) examination revealed no signs of encephalitis, and CSF polymerase chain reaction (PCR) for SARS-CoV-2 was negative. MRI findings revealed focal T2/FLAIR hyperintensity in the bilateral parietooccipital regions, leading to the diagnosis of PRES. Deep sedation and strict blood pressure control resulted in a rapid improvement of her symptoms, and she was discharged without sequelae.
Conclusions: We report the first case of PRES associated with SARS-CoV-2 infection in a patient undergoing maintenance haemodialysis. Patients undergoing maintenance haemodialysis are at high risk of PRES because of several risk factors. SARS-CoV-2 infection causes direct invasion of endothelial cells by binding to angiotensin-converting enzyme 2 (ACE2), initiating cytokine release, and hypercoagulation, leading to vascular endothelial cell injury and increased vascular leakage. In the present case, SARS-CoV-2 infection possibly be associated with the development of PRES.
Keywords: End-stage kidney disease; Haemodialysis; Intravascular endothelial cell injury; Posterior reversible encephalopathy syndrome; Status epilepticus.