Background: Posterior reversible encephalopathy syndrome (PRES) is a rare acute or subacute clinicoradiologic disorder. Systemic lupus erythematosus (SLE) is associated with irreversibility, recurrence, and poor prognosis of PRES. Delayed treatment of PRES in SLE can lead to significant neurological deficits and mortality. 

Objective: To collect case series of SLE patients with PRES treated in Nongkhai Hospital between 2012 and 2023 and compare with other studies. 

Materials and Methods: The medical records of SLE patients with PRES were reviewed and collected. The following information were obtained, gender, occupation, age at SLE diagnosis, age of onset, duration of disease, comorbid or risks, SLE disease activity, glucocorticoids, and immunosuppressants administered before or at diagnosis, clinical presentations, laboratory data, neuroimaging, treatments, complications, length of stay, and outcomes.

Results: Six hundred eleven patients with SLE were identified. Five patients developed PRES. All patients received prednisone with a mean dose of 26.0 (SD 10.4) mg/day before the onset of PRES. Seizures were displayed by all patients. The mean systolic blood pressure was 163.4 (SD 6.3) mmHg. The occipital lobe was the most common brain lesion. Lupus nephritis was observed in all patients. Three of five patients needed intubation and were admitted for closed monitoring in the intensive care unit (ICU). The most common complications during admission were infections, especially sepsis. All patients recovered completely.

Conclusion: The present study suggested that SLE patients with hypertension presenting with seizures and high systolic blood pressure along with a history of moderate to high dose steroids and/or immunosuppressants should always be suspected of PRES. Meanwhile, computerized tomography (CT) and/or magnetic resonance imaging (MRI) brain are the most important tools to establish an early diagnosis. Individualized treatment should be based on clinical presentations, and disease activity evaluation, especially lupus nephritis. Accordingly, sepsis prevention, and ICU admission in severe cases are crucial for a favorable outcome.

Received 7 November 2023 | Revised 24 February 2024 | Accepted 6 March 2024

DOI:10.35755/jmedassocthai.2024.5.13985