Authors: Vinay Kumar Rastog , Paras Passi , Shashank Sadhwani , Prashant Surolia

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) is an acute or subacute cerebral syndrome, the main manifestations of which are headache, encephalopathy, seizures, or visual disturbances in various combinations; this case describes PRES related to drugs and toxic agents.

Case Presentation: We present a case of a 61-year-old female with a history of rheumatoid arthritis, hypothyroidism, dyslipidemia, and drug-induced neutropenia who developed PRES following the use of tab leflunomide. The patient presented with intense generalized itching, erythematous rash, and acute headache, progressing to confusion. Neuroimaging revealed leptomeningeal enhancement in the parieto-occipital regions, consistent with PRES. Prompt treatment with pulse steroid therapy, antihypertensive, and discontinuation of the tab leflunomide led to complete recovery.

Conclusion: This case highlights the importance of early recognition and management of triggering agent causing PRES in patients with autoimmune diseases on immunosuppressant therapy.

Keywords: Hypothyroidism, immunosuppressant therapy, posterior reversible encephalopathy syndrome (PRES), rheumatoid arthritis, case report.