Posterior reversible encephalopathy syndrome as a complication of acute lupus activity

Objectives: We aimed to describe the clinical and imaging characteristics; associated risk factors and neurological outcome of posterior reversible encephalopathy syndrome (PRES) in patients with systemic lupus erythematosus (SLE). Methods: From October 2001 to January 2007, we identified patients with SLE and the criteria for PRES in our institution, which is a tertiary-care referral center for patients with SLE; the patients were evaluated at baseline and followed to determine the clinical outcome. Results: We identified 22 episodes of PRES in 21 patients; 20 (95.2%) were women, mean age of onset was 24.9 +/- 8.6 years, all patients had high systemic activity (SLEDAI scores from 12 to 39). Acute hypertension was observed in 18 episodes (81.8%), and renal failure in 16 (72.7%); only 3 patients were on cyclophosphamide at the time of the onset of PRIES. Persistent neurological deficit was observed in 2 cases; one patient died during the acute episode. Conclusions: PRES is a central nervous system syndrome that is observed in SLE patients. It was associated mainly to high systemic activity, acute hypertension, and renal failure. Although reversibility is common, residual neurological damage may be observed. (C) 2008 Elsevier B.V. All rights reserved.