Occurrence of Reversible Posterior Leukoencephalopathy Syndrome in a Continuous Ambulatory Peritoneal Dialysis Patient

A 25 year-old man presented with reversible posterior leukoencephalopathy syndrome manifesting as seizure, loss of consciousness and severe hypertension. He had contracted end stage kidney disease due to Alport syndrome and was treated with continuous ambulatory peritoneal dialysis for one year. Because his residual renal function was declining, he had refractory hypertension for several months before admission. On the admission, brain T-2 intensified magnetic resonance imaging revealed hyperintensive changes that were restricted to the cortex and the subcortical white matter of the parietal lobe, temporal lobe and posterior lobe. His clinical symptoms were improved by appropriate control of blood pressure using antihypertensive drugs and fluid depletion by continuous hemodiafiltration. Previous hyperintensive lesions disappeared in brain magnetic resonance imaging. He was transferred to maintenance hemodialysis three times weekly and discharged. One month later, he had a seizure attack again because of refractory hypertension which may be derived from low compliance with sodium and water restriction. We report here a reversible posterior leukoencephalopathy syndrome patient on peritoneal dialysis with severe hypertension and volume overload.