Abstract：
BACKGROUND: Posterior leukoencephalopathy syndrome (PRES) is a rare neurological disease possibly associated with the use of calcineurin inhibitors like cyclosporine A (CSA). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for the outbreak of coronavirus disease 19 (COVID-19) can cause neurological manifestations. We described a case of CSA-related PRES whose diagnosis was difficult due to a concurrent infection with SARS-CoV-2.
METHODS: The 16-year-old patient was known to have corticosteroid-resistant nephrotic syndrome secondary to minimal change disease. CSA was introduced, and on the fifth day of treatment, the patient presented with seizures followed by fever. Biological and magnetic resonance imaging data were in favor of SARS-CoV-2 encephalitis. Relief of immunosuppression by discontinuation of CSA was decided and the patient was put on anticonvulsants. After being declared cured of COVID-19, which was without other clinical signs, the CSA was reintroduced but the patient presented with seizures the next day. This allowed the physicians to rectify the diagnosis and relate the seizures to a CSA-related PRES.
CONCLUSIONS: Infection with SARS-CoV-2 could be a differential diagnosis of a PRES related to calcineurin inhibitors.
METHODS: The 16-year-old patient was known to have corticosteroid-resistant nephrotic syndrome secondary to minimal change disease. CSA was introduced, and on the fifth day of treatment, the patient presented with seizures followed by fever. Biological and magnetic resonance imaging data were in favor of SARS-CoV-2 encephalitis. Relief of immunosuppression by discontinuation of CSA was decided and the patient was put on anticonvulsants. After being declared cured of COVID-19, which was without other clinical signs, the CSA was reintroduced but the patient presented with seizures the next day. This allowed the physicians to rectify the diagnosis and relate the seizures to a CSA-related PRES.
CONCLUSIONS: Infection with SARS-CoV-2 could be a differential diagnosis of a PRES related to calcineurin inhibitors.
摘要：
背景：后部白质脑病综合征（PRES）是一种罕见的神经系统疾病，可能与使用钙调磷酸酶抑制剂如环孢菌素A（CSA）有关。导致冠状病毒病19（COVID-19）爆发的严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）可引起神经系统表现。我们描述了一例与CSA相关的PRES，由于并发感染SARS-CoV-2而难以诊断。
方法：已知该16岁患者继发于微小病变的皮质类固醇耐药型肾病综合征。CSA被引入，在治疗的第五天，患者出现癫痫发作，然后发烧。生物和磁共振成像数据有利于SARS-CoV-2脑炎。决定通过停用CSA来缓解免疫抑制，并对患者使用抗惊厥药。在被宣布治愈COVID-19后，没有其他临床症状，CSA被重新引入,但患者在第二天出现癫痫发作.这使医生能够纠正诊断并将癫痫发作与CSA相关的PRES联系起来。
结论：SARS-CoV-2感染可能是与钙调磷酸酶抑制剂相关的PRES的鉴别诊断。
方法：已知该16岁患者继发于微小病变的皮质类固醇耐药型肾病综合征。CSA被引入，在治疗的第五天，患者出现癫痫发作，然后发烧。生物和磁共振成像数据有利于SARS-CoV-2脑炎。决定通过停用CSA来缓解免疫抑制，并对患者使用抗惊厥药。在被宣布治愈COVID-19后，没有其他临床症状，CSA被重新引入,但患者在第二天出现癫痫发作.这使医生能够纠正诊断并将癫痫发作与CSA相关的PRES联系起来。
结论：SARS-CoV-2感染可能是与钙调磷酸酶抑制剂相关的PRES的鉴别诊断。
