Posterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant

Hypomagnesemia is found in 12% of hospitalized patients and up to 60% of intensive care unit patients and is associated with a variety of organ dysfunction. Posterior reversible encephalopathy syndrome is a neurologic hyperperfusion disorder that mostly affects posterior portions of the brain. Vario...

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Autores principales:	Mohammad Alsultan, Qussai Hassan
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	hypomagnesemia posterior reversible encephalopathy syndrome hypoparathyroidism clostridium difficile Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/c0c9d5021410486f97d80bec909dbe2f
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spelling	oai:doaj.org-article:c0c9d5021410486f97d80bec909dbe2f2021-11-18T11:08:45ZPosterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant1662-680X10.1159/000519883https://doaj.org/article/c0c9d5021410486f97d80bec909dbe2f2021-10-01T00:00:00Zhttps://www.karger.com/Article/FullText/519883https://doaj.org/toc/1662-680XHypomagnesemia is found in 12% of hospitalized patients and up to 60% of intensive care unit patients and is associated with a variety of organ dysfunction. Posterior reversible encephalopathy syndrome is a neurologic hyperperfusion disorder that mostly affects posterior portions of the brain. Various theories were proposed to explain whether hypomagnesemia is etiology or associated with posterior reversible encephalopathy syndrome (PRES). A patient with kidney transplantation suffered from fatigue and reduced urine output due to chronic diarrhea induced by Clostridium difficile. Hypoparathyroidism in addition to persistent hypocalcemia and hypokalemia was observed and suggested magnesium depletion with normal serum levels. Thereafter, the status was complicated with delirium, seizures, and coma. Neurological status rapidly improved after adding intravenous magnesium sulfate to antiepileptic drugs. The second magnetic resonance imaging (MRI) showed vasogenic edema compatible with posterior reversible encephalopathy syndrome. Therefore, magnesium depletion, with normal serum levels, was considered the most implicated etiology of the syndrome in this patient. Also, hypomagnesemia during the acute phase of the syndrome and excluding all other etiology support this theory. Our case highlights hypomagnesemia-induced PRES, despite the normal serum level. Serum magnesium dropped during the acute phase of PRES, and magnesium should be maintained at the high normal limit, regardless of normal serum level. MRI findings might present after few days of symptoms; this might delay appropriate treatment.Mohammad AlsultanQussai HassanKarger Publishersarticlehypomagnesemiaposterior reversible encephalopathy syndromehypoparathyroidismclostridium difficileNeurology. Diseases of the nervous systemRC346-429ENCase Reports in Neurology, Vol 13, Iss 3, Pp 693-698 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hypomagnesemia posterior reversible encephalopathy syndrome hypoparathyroidism clostridium difficile Neurology. Diseases of the nervous system RC346-429
spellingShingle	hypomagnesemia posterior reversible encephalopathy syndrome hypoparathyroidism clostridium difficile Neurology. Diseases of the nervous system RC346-429 Mohammad Alsultan Qussai Hassan Posterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant
description	Hypomagnesemia is found in 12% of hospitalized patients and up to 60% of intensive care unit patients and is associated with a variety of organ dysfunction. Posterior reversible encephalopathy syndrome is a neurologic hyperperfusion disorder that mostly affects posterior portions of the brain. Various theories were proposed to explain whether hypomagnesemia is etiology or associated with posterior reversible encephalopathy syndrome (PRES). A patient with kidney transplantation suffered from fatigue and reduced urine output due to chronic diarrhea induced by Clostridium difficile. Hypoparathyroidism in addition to persistent hypocalcemia and hypokalemia was observed and suggested magnesium depletion with normal serum levels. Thereafter, the status was complicated with delirium, seizures, and coma. Neurological status rapidly improved after adding intravenous magnesium sulfate to antiepileptic drugs. The second magnetic resonance imaging (MRI) showed vasogenic edema compatible with posterior reversible encephalopathy syndrome. Therefore, magnesium depletion, with normal serum levels, was considered the most implicated etiology of the syndrome in this patient. Also, hypomagnesemia during the acute phase of the syndrome and excluding all other etiology support this theory. Our case highlights hypomagnesemia-induced PRES, despite the normal serum level. Serum magnesium dropped during the acute phase of PRES, and magnesium should be maintained at the high normal limit, regardless of normal serum level. MRI findings might present after few days of symptoms; this might delay appropriate treatment.
format	article
author	Mohammad Alsultan Qussai Hassan
author_facet	Mohammad Alsultan Qussai Hassan
author_sort	Mohammad Alsultan
title	Posterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant
title_short	Posterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant
title_full	Posterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant
title_fullStr	Posterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant
title_full_unstemmed	Posterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant
title_sort	posterior reversible encephalopathy syndrome induced by hypomagnesemia due to clostridium difficile in a patient with kidney transplant
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/c0c9d5021410486f97d80bec909dbe2f
work_keys_str_mv	AT mohammadalsultan posteriorreversibleencephalopathysyndromeinducedbyhypomagnesemiaduetoclostridiumdifficileinapatientwithkidneytransplant AT qussaihassan posteriorreversibleencephalopathysyndromeinducedbyhypomagnesemiaduetoclostridiumdifficileinapatientwithkidneytransplant
_version_	1718420868365811712

Posterior Reversible Encephalopathy Syndrome Induced by Hypomagnesemia due to Clostridium Difficile in a Patient with Kidney Transplant

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