Posterior reversible encephalopathy syndrome in systemic lupus erythematosus: Comment on the article by Efthimiou et al

Abstract

To the Editor: Efthimiou and colleagues described a case of posterior reversible encephalopathy syndrome (PRES) in a 30-year-old female patient with hypertension and systemic lupus erythematosus (SLE) (1). This case adds to the increasing evidence that SLE can present with PRES (2–4). However, we have some concerns about the diagnosis of this case. Primarily arising from a failure of cerebrovascular autoregulation and disruption of the blood–brain barrier, PRES is characterized by reversible vasogenic edema in the brain, mainly implicating posterior white matter (5). Although hyperintensity can be seen on fluid-attenuated inversion recovery magnetic resonance imaging, diffusion-weighted imaging and an apparent diffusion coefficient mapping are indispensible to differentiate vasogenic edema of PRES from cytotoxic edema, as well as ischemia. The central nervous system complications of SLE are not uncommon; these include vasculitis (6), acute or subacute infarction (7), and PRES, among others. Both vasculitis and PRES may present with reversible lesions in the brain. Therefore, reversible vasogenic edema, preferably involving posterior white matter, can be a key to differentiating PRES from other reversible lesions in SLE. In summary, PRES appears common in SLE. However, the diagnosis of PRES might be confounded by other pathologic changes of SLE.