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Posterior reversible encephalopathy syndrome (first report for hydroxychloroquine)?: case report A 23-year-old woman with systemic lupus erythematosus (SLE) developed posterior reversible leukoencephalopathy syndrome (PRES) whilst receiving hydroxychloroquine and mercaptopurine [dosages and duration of treatment to reaction onset not stated]. The woman, who had a 9-year history of SLE that was controlled with low-dose oral steroids, hydroxychloroquine and mercaptopurine, was admitted because of a worsening skin rash. Investigations showed a normal BP, lupus biomarkers and renal function and she started receiving methylprednisolone. However, over the next few days, her level of consciousness and verbal responsiveness deteriorated until she could only respond to painful stimuli. Her BP and renal function remained normal, but a brain MRI showed increased T2 signals in both thalami and cerebral peduncles with facilitated diffusion on diffusion-weighted imaging; there was also patchy enhancement of the thalamic lesions. Other investigations failed to reveal any other causes of her altered mental status and abnormal MRI findings. The woman received cyclophosphamide and the dosage of IV methylprednisolone was increased. Her alertness gradually improved over the next 6 days, and 8 months after the incident, her MRI result had normalised. Author comment: "The most likely underlying mechanism if PRES in this patient is altered immune homeostasis due to SLE itself . . . Alternatively, PRES in this case is secondary to mercaptopurine or hydroxychloroquine therapy: a new association." Bag AK, et al. Central variant of posterior reversible encephalopathy syndrome in systemic lupus erythematosus: New associations? Lupus 19: 225-226, No. 2, Feb 2010. Available from: URL: http://dx.doi.org/10.1177/0961203309345749 803009945 USA

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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of PRES associated with hydroxychloroquine. The WHO ADR database contained one report of reversible posterior leukoencephalopathy syndrome associated with hydroxychloroquine.

0114-9954/10/1297-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved

Reactions 17 Apr 2010 No. 1297