소아에서 발생한 연쇄구균 감염 후 사구체 신염에 의한 가역성 후두부 뇌병증 증후군 1례

A Case of Posterior Reversible Encephalopathy Syndrome with Post Streptoccocal Glomerulonephritis

저자들은 10세 남아에서 발생한 연쇄구균 감염 후 사구체 신염에서 일시적인 혈압상승 후 나타난 가역성 후두부 뇌병증 증후군 1례를 경험하였다. 갑작스런 의식장애와 시력장애 및 경련이 동반된 혈압상승시 고혈압성 뇌병증 및 혈압 상승이 동반된 중추신경감염성 질환이나 두개강내 종양과 경련성 질환을 감별해야 하며 가역성 후두부 뇌병증 증후군을 고려하여 MRI를 시행하는 것이 중요하다.

Posterior Reversible Encephalopathy Syndrome(PRES) mainly develops in patients under immunosuppressive therapy after transplantation, or patients who suffer hemato-oncologic diseases, eclampsia, acute hypertensive encephalopathy related with nephrotic disease. Sudden headache, nausea, mental derangement, convulsion, vision problems are the main symptoms shown in PRES. It typically shows edema of occipito-parietal area of cortex or subcortex in Magnetic Resonance Imaging(MRI). A 10-year-old male was hospitalized with the chief complaint of headache, vomiting and dizziness for 3 days. He was treated for upper respiratory infection for 1 week before the hospitalization. Initial blood pressure was 145/95 mmHg, which was high for his age. Uninalysis showed microscopic hematuria(3＋). The hypertension persisted even after the hospitalization, and re-checked blood pressure was 175/115 mmHg. The patient complained of headache, and after that, he suffered from alteration of mental status with dysarthria and generalized type of seizure events. The MRI showed lesions suggestive of PRES. He recovered to alertmental status after the blood pressure was controlled. Antistreptolysin-O(ASO) titer was increased and complement 3(C3) titer was decreased. The follow up MRI taken 1 month after the event became normal. We report a case of PRES related with contemporary hypertensive event in Acute Post-Streptococcal Glomerulonephritis(APSGN).