BMJ Case Reports 2018; doi:10.1136/bcr-2018-225128
  • Rare disease

A case of posterior reversible encephalopathy syndrome associated with sepsis

  1. Alfredo Iardino
  1. Department of Internal Medicine, Texas Tech University Health Science Center at Permian Basin, Odessa, Texas, USA
  1. Correspondence to Dr Alfredo Iardino, alfredo.iardino{at}
  • Accepted 26 June 2018
  • Published 10 July 2018


Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterised by parieto-occipital vasogenic oedema seen on MRI. Infection and sepsis has been reported as a possible cause for this disorder.

We present a 19-year-old immunocompetent Caucasian man with known type 1 diabetes mellitus who presented to the emergency department with acute onset of bilateral visual loss, headaches and hypertension; he had been discharged 2 weeks ago for severe diabetic ketoacidosis and Staphylococcus aureus bacteraemia. Initial CT scan of the head was negative, but MRI showed findings suggestive of PRES. He was treated with nicardipine drip for strict blood pressure management and symptoms resolved within 4 days. PRES is a rare disease that has been increasingly reported as MRI becomes more commonplace. Usually associated with immunological disease, pre-eclampsia and cytotoxic therapies but an association with sepsis due to gram-positive bacteria.


  • OG and AI contributed equally.

  • Contributors OG and AR: writing of manuscript, patient care, radiological review, editing of images. AI: writing of manuscript, patient care, radiological review, editing of images. Final manuscript approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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