RT Journal Article SR Electronic T1 Polyarteritis nodosa presenting with posterior reversible leukoencephalopathy syndrome JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e250867 DO 10.1136/bcr-2022-250867 VO 15 IS 8 A1 Rosie Heartshorne A1 May Nwe A1 Athar Barakat A1 Sundus Alusi YR 2022 UL http://casereports.bmj.com/content/15/8/e250867.abstract AB 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.