Posterior reversible encephalopathy syndrome as a rare presentation of systemic lupus erythematosus: a case report

Introduction and importance: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical-radiological entity characterized by the rapid onset of neurological symptoms accompanied by typical radiological signs of vasogenic edema predominantly in the posterior brain region. Numerous causes can contribute to PRES, including hypertension, renal failure, pre-eclampsia, and immunosuppression. Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder involving several immune dysfunctions and can affect the central nervous system. Although rare, cases of PRES have been documented in individuals diagnosed with SLE. Case presentation: We here describe a case of an 18-year-old female who was newly diagnosed with SLE and experienced generalized tonic and clonic seizures during treatment as an inpatient in the hospital. On further evaluation for the cause of the seizure, the presence of PRES was found in a brain MRI. The patient condition was managed with antiepileptic medication and kept on regular BP monitoring. For the management of SLE, due to infertility risk, the patient was discharged on mycophenolate mofetil. Clinical discussion: PRES is an uncommon but recognized complication in SLE, often triggered by hypertension, immunosuppressive therapy, or disease activity. MRI remains the diagnostic gold standard, revealing characteristic posterior white matter changes. Early recognition and supportive management, including seizure control, can lead to complete recovery and prevent long-term deficits. Conclusion: PRES, though rare in SLE, should be considered in patients with seizures, altered mental status, and visual disturbances with supportive brain imaging. Further research is needed to clarify its mechanisms and improve management.