Peer Review Report For: Case Report: Binocular blindness in reversible posterior encephalopathy syndrome revealing lupus [version 1; peer review: 1 approved, 1 approved with reservations]

Résumé

Optic neuropathy is very rare and exceptionally inaugural in systemic erythematous lupus erythematosus (SLE), and posterior reversible encephalopathy syndrome (PRES) is a novel clinical disorder. What makes this observation unique is the combination of these two pathologies. We hereby present the case of a severe presentation of PRES in a 15-year-old girl who was transferred to the intensive care unit for worsening hypertension and abdominal pain. The patient was first admitted to the adult medical department for sudden onset of binocular blindness. Therefore, antihypertensive drugs were prescribed and mechanical ventilation was required as she presented a refractory status epilepticus. A head computed tomography and MRI supported the diagnosis of PRES. The course was marked by a coherent awakening, progressive improvement in blood pressure and recovery of normal vision after 2 days. The patient was transferred to the nephrology department for renal biopsy. The diagnosis of SLE was based on four ACR criteria: positive ANA, positive anti-DNA, proteinuria greater than 0.5 g/l and lymphopenia. In the presence of PRES, there should be no hesitation in requesting an immunological workup to look for a systemic disease. Despite a worrying clinical and radiological presentation, the prognosis of PRES remains favorable.

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