A case of posterior reversible encephalopathy syndrome caused by hemolytic uremic syndrome associated with O-157 infection

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by neurological symptoms including headache, seizures, disturbance of consciousness, and abnormalities of the white matter of the posterior lobe on imaging studies. We describe a first case of PRES associated with hemolytic uremic syndrome (HUS) in Japan. A 83-year- old woman was hospitalized with abdominal pain and melaena. Her mental status was depressed and she developed a seizure on the 3rd hospital day. Escherichia coli O-157 and verotoxin were detected and no abnormalities were found on brain CT or MRI. On the 6th hospital day, CT showed the low-density areas in right posterior lobe and bilateral external capsules. The consciousness level was improved gradually, and the low density areas were obscured on the 19th hospital day, and disappeared on the 27th hospital day. We therefore diagnosed encephalopathy as PRES clinically. PRES might be due to the damage to endothelial cells caused by HUS. Consciousness disturbances with HUS should be followed by CT or MRI with the possibility of PRES in mind.