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Polyarteritis nodosa presenting with posterior reversible leukoencephalopathy syndrome
  1. Rosie Heartshorne,
  2. May Nwe,
  3. Athar Barakat and
  4. Sundus Alusi
  1. Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Rosie Heartshorne; r.heartshorne{at}


A man in his 20s presented following a generalised tonic–clonic seizure on a background of a recent diagnosis of hepatitis B (HBV). During admission, he was severely hypertensive and imaging findings confirmed a diagnosis of posterior reversible leukoencephalopathy syndrome (PRES). The patient subsequently developed multiorgan involvement with an axonal sensorimotor neuropathy, vascular cutaneous lesions and multiple bilateral renal and splenic infarcts. Based on the 2012 Revised International Chapel Hill Consensus Criteria, a diagnosis of polyarteritis nodosa (PAN) with secondary PRES was made. The patient was given intravenous methylprednisolone, followed by a prolonged course of oral prednisolone, and tenofovir antiviral therapy to target HBV seroconversion. He made a good neurological recovery with resolution of imaging changes. This case highlights the importance of a low threshold for systemic screening for young patients presenting with PRES secondary to uncontrolled hypertension and the importance of viral screening, particularly for HBV.

  • Vasculitis
  • Hepatitis B
  • Epilepsy and seizures
  • Proteinurea

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  • Contributors RH wrote the initial draft of the manuscript and the literature review. MN summarised the neurophysiology results and performed a literature search and review of the peripheral nerve manifestations. MN also provided additional contributions with editions to subsequent drafts. AB reviewed and analysed all imaging, created the corresponding figures and summarised the imaging with corresponding literature review. RH provided the main contribution to subsequent editions of the manuscript and formatting as well as the submission process. SA was the responsible clinician for the patient during their admission. SA was the principal author to proof read and edit the manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.