Objective: To present and analyze two pediatric cases of posterior reversible encephalopathy syndrome (PRES) occurring in the context of distinct nephrological conditions, and to highlight the importance of early recognition and intervention in preventing permanent neurological damage. Design and method: A retrospective review of two clinical cases was conducted. The first involved a 12-year-old female patient diagnosed with systemic lupus erythematosus (SLE) and suspected macrophage activation syndrome (MAS), treated with high-dose glucocorticoids, cyclosporine, and mycophenolate mofetil. The second case concerned a pediatric patient with acute post-infectious glomerulonephritis. Clinical presentation, radiological findings, therapeutic strategies, and patient outcomes were evaluated. Results: Both patients presented with neurological symptoms, including seizures or severe headache, accompanied by markedly elevated blood pressure. Brain magnetic resonance imaging (MRI) in both cases demonstrated characteristic subcortical edema consistent with PRES. Despite differences in underlying diagnoses and clinical features, both patients showed favorable responses to prompt antihypertensive and supportive treatment. Neurological symptoms resolved, and radiological abnormalities regressed. Conclusions: PRES can develop in pediatric patients with renal disorders of varying etiologies, including autoimmune and post-infectious conditions. Hypertension is a common and likely pivotal trigger. Early diagnosis and appropriate management are essential to ensure complete neurological recovery and to prevent irreversible complications.
Madej-Swiatkowska et al. (Fri,) studied this question.