Bilateral Visual Loss as Presenting Symptom of Posterior Reversible Encephalopathy Syndrome in a Patient with HIV/Tuberculosis Coinfection: A Case Report

S Guerriero,T Centoducati,L, Ciracì,F Pignatelli,A Salvati,F Dicuonzo,V Lamargese

doi:10.1155/2012/850176

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state accompanied by a unique brain imaging pattern. This cliniconeuroradiological entity usually presents with visual disturbances (cortical blindness, homonymous hemianopia, visual neglect, and blurred vision) along with neurotoxic manifestations. Only a few cases of PRES have previously been reported in patients with advanced HIV disease. The authors describe a case of posterior reversible encephalopathy syndrome (PRES) in a patient with advanced HIV/TBC infection who developed a neurotoxic state following TB and ART therapy initiation. They present a comprehensive review of the literature and discuss the pathogenetic hypotheses.

Highlights

Posterior reversible encephalopathy syndrome (PRES), known as reversible posterior leukoencephalopathy syndrome (RPLS), is a syndrome characterized by headache, confusion, seizures, and visual loss.It is usually seen on computed tomographic scans as white-matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain [1, 2]
She was diagnosed with advanced HIV infection (CD4 count, 29/μl, HIV-1-RNA viral load >than 750 000 copies/ml) and disseminated tuberculosis (TB). (Quantiferon test was positive, and this result was confirmed by the study of the sputum which was positive for the presence of alcohol acid resistant bacilli.) Total body CT spotted the presence of an abdominal abscess, supposedly TBC related
PRES is a neurotoxic state characterized by headache, nausea and vomit, altered mental status, seizures, coma, and visual disturbance [1]

Summary

Introduction

Posterior reversible encephalopathy syndrome (PRES), known as reversible posterior leukoencephalopathy syndrome (RPLS), is a syndrome characterized by headache, confusion, seizures, and visual loss.It is usually seen on computed tomographic scans as white-matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain [1, 2]. Risk factors include malignant hypertension, eclampsia, medications such as immunosuppressants, chemotherapy, and biotherapy, and renal failure. Very few HIV-positive patients with PRES have been reported. We here present an AIDS patient with disseminated (including central nervous system) tuberculosis (TB) who developed PRES following TB and antiretroviral therapy (ART) initiation

Case Report

Discussion

Conflict of Interests