2022 Volume 35 Issue 2 Pages 101-108
A 6-year-old boy started to receive oral prednisolone for an incipient nephrotic syndrome. Two weeks later, he started to receive a calcium antagonist because of hypertension. Another two weeks later, he was still not in complete remission; therefore a renal biopsy was performed, and a pathological diagnosis of focal segmental glomerulosclerosis syndrome was made. The day after the renal biopsy, his systolic blood pressure was in the 120 mmHg range, and he had impaired consciousness and conjugate deviation to the left. We diagnosed him with posterior reversible encephalopathy syndrome. Continuous intravenous infusion of nicardipine and that of midazolam were started, fosphenytoin and phenobarbital were administered, and continuous electroencephalogram monitoring was performed. After an electroencephalogram showed a decreasing tendency of spike-and-wave discharges, his consciousness recovered, and his imaging findings improved. An angiotensin-converting enzyme inhibitor was administered, and his systolic blood pressure fell to around 100 mmHg. Administration of prednisolone was tapered and discontinued, and his urine total protein to creatinine ratio (g/g·Cr) fell under 0.5. It is of note that pediatric patients with renal disease have many risk factors for posterior reversible encephalopathy syndrome and may develop it even in the absence of significant hypertension or immunosuppressive medication.
