Posterior Reversible Encephalopathy Syndrome Following Cadaveric-Donor Kidney Transplantation; A Challenging Diagnosis

A 19-year-old girl with haemolytic uraemic syndrome (HUS) and hypertension underwent a diseased donor kidney transplantation. She developed two episodes of generalised tonic-clonic convulsions on the second postoperative day. Posterior reversible encephalopathy syndrome (PRES) was diagnosed based on the history and imaging. PRES was likely as it is associated with factors which co-exist with chronic kidney disease. Perioperative MMF, tacrolimus and prednisolone were prescribed by the nephrologist. Her serum tacrolimus level was normal at the time of convulsions. Other causes of seizures such as hypoglycaemia, electrolyte abnormalities, infection and intracranial haemorrhages were excluded. Elevated blood pressure associated with severe visual impairment was noted during the second episode of convulsions. Clinical diagnosis was confirmed by magnetic resonance imaging (MRI). She had a complete recovery without residual neurological deficits. Her blood pressure was controlled at the time of discharge and she had a well-functioning graft. Timely detection and institution of early treatment led to a successful recovery.