A posterior reversible encephalopathy syndrome in a young patient with goodpasture's disease

Background

Posterior reversible encephalopathy syndrome (PRES) is a neurovascular condition characterized by headache, seizures, altered mental status, and visual disturbances. It is associated with risk factors such as hypertension, renal failure, and immunosuppressive therapy. The occurrence of PRES in patients with Goodpasture's disease is rare and often under-recognized in emergency settings.

Case presentation

A 27-year-old man with recently diagnosed Goodpasture's disease presented to the emergency department with a thunderclap headache. He subsequently developed status epilepticus, associated with severe hypertension and acute kidney injury. CT imaging revealed bilateral posterior juxtacortical hypodensities suggestive of PRES, later confirmed by magnetic resonance imaging. Emergency treatment included intravenous nicardipine, clonazepam, and levetiracetam adjusted for renal impairment. The patient was admitted to the intensive care unit, where he developed transient cortical blindness, a well-documented complication of PRES. Following multiple dialysis sessions and clinical stabilization, his visual and neurological function fully recovered.

Conclusion

This case highlights the importance of considering PRES in patients presenting with seizures and hypertension, particularly in the context of autoimmune disease and renal impairment. Early recognition and prompt treatment in the emergency department are crucial to prevent potentially irreversible neurological damage. Emergency clinicians should maintain a high index of suspicion when evaluating thunderclap headaches with seizure activity, especially in immunosuppressed patients.