Posterior reversible encephalopathy syndrome in a child with bronchial asthma.

Although posterior reversible encephalopathy syndrome (PRES) is caused by various conditions, there have been no reports on PRES associated with bronchial asthma. We report a case with PRES during the treatment for severe asthmatic attack. A 4-year-old girl was treated for asthmatic attack with steroids. From the 10th hospital day, hypertension, pulmonary edema, and cardiomegaly were observed. In spite of treatment with furosemide, she became lethargic and had a generalized convulsion on the 23rd hospital day. CT showed low density areas in the bilateral occipital white matter and MRI on the 28th hospital day demonstrated high intensity areas in the same regions on T2-weighted and FLAIR images. After discontinuation of corticosteroid and further antihypertensive therapy, her consciousness improved. MRI on the 67th hospital day had no abnormalities and no neurological sequelae were seen at 2 years after the event. We should be aware that PRES is a rare but important adverse event related to steroid therapy, because hypertension and water retention are major adverse effects of steroids.

[Effects of dexamethasone on apoptosis of eosinophils infiltrated into bronchoalveolar lavage fluid after Sephadex bead treatment in rat].

Eosinophilic inflammation of the airways is a key characteristic of asthma. Glucocorticoids can suppress the inflammatory response in part by promotion of eosinophilic apoptosis. We investigated the effects of glucocorticoids on leukocyte infiltration and apoptotic resolution of eosinophils and neutrophils in Sephadex-treated rat lung. Sephadex beads were injected intravenously, followed 24 h later by i.p. administration of dexamethasone (DEX, 0.1 mg/kg) or its vehicle. At 24 h post-DEX treatment, the bronchoalveolar lavage fluid (BALF) was collected. Differential leukocyte counts and the numbers of apoptotic eosinophils and neutrophils, and macrophages with engulfed eosinophils or neutrophils in BALF were determined microscopically from Diff-Quik stained cytospin preparations. Sephadex beads markedly increased cell counts of eosinophils and neutrophils in BALF. Compared with a vehicle-treated group, the DEX treatment significantly decreased the number of eosinophils, but not neutrophils, in BALF. Dexamethasone in BALF also significantly increased eosinophilic apoptosis and engulfment of apoptotic eosinophils by macrophages, but had no effect on neutrophilic apoptosis and engulfment of apoptotic neutrophils by macrophages. These results suggest that the increased clearance of eosinophils from airways by glucocorticoids may be partly due to the promotion of eosinophilic apoptosis.