26rhk091 10.3205/26rhk091 urn:nbn:de:0183-26rhk0917 Meeting Abstract Ermeidis Ermeidis Georgios G

National and Kapodistrian University of Athens, Clinic of Pathophysiology, Athens, Griechenland

author Ziaragkali Ziaragkali Sevastiani S

National and Kapodistrian University of Athens, Clinic of Pathophysiology, Athens, Griechenland

author Polyzou Polyzou Maria M

Ruhr University of Bochum, Rheumazentrum Ruhrgebiet, Herne, Deutschland National and Kapodistrian University of Athens, Clinic of Pathophysiology, Athens, Griechenland

author Karamanof Karamanof Georgios G

National and Kapodistrian University of Athens, Clinic of Pathophysiology, Athens, Griechenland

author Euthimiou Euthimiou Athina A

Laiko General Hospital, Department of Neurology, Athens, Griechenland

author Goules Goules Andreas A

National and Kapodistrian University of Athens, Clinic of Pathophysiology, Athens, Griechenland

author Vlachogiannopoulos Vlachogiannopoulos Panagiotis P

National and Kapodistrian University of Athens, Clinic of Pathophysiology, Athens, Griechenland

author German Medical Science GMS Publishing House

Düsseldorf

610 20260909 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). M0656 091 Deutsche Gesellschaft für Rheumatologie Deutsche Gesellschaft für Orthopädische Rheumatologie Gesellschaft für Kinder- und Jugendrheumatologie 54. Kongress der Deutschen Gesellschaft für Rheumatologie und Klinische Immunologie (DGRh), 36. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR), 40. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh) Deutscher Rheumatologiekongress 2026 Der besondere Fall Leipzig 20260909 20260912 FA.07 TextHistory: A 45-year-old female presented with a 10-day history of fever (up to 38.6°C), headache, and vomiting. Her medical history included well-controlled Systemic Lupus Erythematosus (SLE) since 2019, initially characterized by photosensitive rash, peripheral arthralgias, pleuritis, Raynaud’s phenomenon, anemia, and leukopenia. Laboratory findings showed ANA (1:320), positive Anti-dsDNA, and low C3/C4 levels. The patient had been in remission for five years on low-dose corticosteroids and hydroxychloroquine.Cardinal symptom by manifestation of disease: She was admitted to the Clinic of Internal Medicine with low-grade fever (37.7°C) and stable vitals. Neurological examination was unremarkable, with no focal signs or meningismus. Workup for infectious causes (blood/urine cultures, viral serology, syphilis, brucellosis, and tuberculosis) was negative. Subsequently, the patient developed worsening headache, blurred vision, and left temporal hemianopsia, followed by a tonic-clonic seizure managed with levetiracetam.Diagnostics: Lumbar puncture revealed cerebrospinal fluid (CSF) with pleocytosis (10 cells/μL, 90%) and a protein level of 200 mg/dL. CSF cultures, FilmArray, and autoimmune/paraneoplastic panels were negative. Brain MRI demonstrated findings attributed to vasogenic edema localized in the cortical-subcortical region of the posterior structures. A diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES) was established triggered by the patient’s underlying systemic autoimmune disease.Therapy: Four biweekly (15-day) cycles of intravenous (IV) cyclophosphamide (500 mg) and one cycle of IV rituximab (two 500 mg doses, 15 days apart) were administered. Levetiracetam therapy was continued.Further course: Two months following treatment with cyclophosphamide and rituximab, clinical improvement was observed, including improved visual acuity and visual fields on repeat ophthalmological assessments, as well as subjective visual improvement reported by the patient. Radiologically, there was regression of the vasogenic edema previously described on MRI.Disclosures: No conflict of interest.Figure 1 Figure 2 Hinchey J Chaves C Appignani B Breen J Pao L Wang A Pessin MS Lamy C Mas JL Caplan LR A reversible posterior leukoencephalopathy syndrome 1996 N Engl J Med 494-500 Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996 Feb 22;334(8):494-500. DOI: 10.1056/NEJM199602223340803 http://dx.doi.org/10.1056/NEJM199602223340803 Legge AC Hanly JG Recent advances in the diagnosis and management of neuropsychiatric lupus 2024 Nat Rev Rheumatol 712-728 Legge AC, Hanly JG. Recent advances in the diagnosis and management of neuropsychiatric lupus. Nat Rev Rheumatol. 2024 Nov;20(11):712-728. DOI: 10.1038/s41584-024-01163-z http://dx.doi.org/10.1038/s41584-024-01163-z 0

1 1 Figure 1: Brain MRI on admission

2 2 Figure 2: Follow-up brain MRI at one month

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