Polyarteritis nodosa presenting with posterior reversible leukoencephalopathy syndrome.

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.

Miller Fischer and posterior reversible encephalopathy syndromes post COVID-19 infection.

COVID-19 infection displays heterogeneity of clinical manifestations in symptomatic and asymptomatic patients. We report on a child with Miller Fischer syndrome (MFS) and posterior reversible encephalopathy syndrome (PRES) post-COVID-19 infection. An 11-year-old boy presented with vomiting, headache, blurred vision, dysarthria, dysphagia, respiratory failure, muscle weakness, and unsteadiness. He had been exposed to COVID-19 through an asymptomatic elder brother two months prior to his illness. The MRI brain showed findings consistent with PRES and the diagnosis with Miller Fischer variant of the Guillain-Barré syndrome was made. A cerebrospinal fluid analysis revealed cytoalbuminous dissociation, and a nerve conduction velocity study conclusively showed polyneuropathy. A fluoroscopy of the diaphragms found that there was limited movement in both. Although children seem to be less affected by COVID-19 infection, this report highlights on an important neurological complications that can develop in children and its presence should be taken into consideration when diagnosing different forms of Guillain-Barré.