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Unusual Case of Severe Hypertension in a 20-Year-Old Woman.

### G. Pichler

A 20-year-old woman was seen in the emergency department because of abdominal pain and hypertension. The patient had no notable medical history, and there were no inherited disorders in her family. She had been well until 1 month before admission, when a sharp, constant, and diffuse abdominal pain developed. The pain was not modified by food intake, defecation or positional changes. The patient did not report anorexia, nausea, retching, or changes in her bowel habits. She had not experienced menstrual disorders or irritative urinary symptoms. Two days before admission a mild generalized headache developed. The patient had been seen in the emergency department 9× since the onset of symptoms, being discharged with different diagnosis including cystitis and nephritic colic among others. Abdominal ultrasonography was normal, and the gynecological evaluation did not show abnormalities. Over the past month, she had been prescribed analgesics and nonsteroidal anti-inflammatory drugs, prokinetics, spasmolytics, and antibiotics, without clinical improvement.

At admission, on physical examination, the patient was alert, uncomfortable but cooperative. Temperature was 36.3°C, blood pressure (BP) was 166/111 mm Hg, pulse was 120 bpm, respiratory rate was 18 breaths/min, and oxygen saturation was 98%. The abdomen was soft and nondistended, with soft bowel sounds and absence of bruits, without hepatomegaly or splenomegaly, or signs of peritoneal inflammation. Peripheral pulses were regular and symmetrical without carotid-femoral delay. The neurological examination did not reveal any abnormality. The laboratory test showed mild hyponatremia (serum sodium, 126 mmol/L) with normal potassium levels (3.8 mmol/L), mild elevation of transaminases and mild leukocytosis (white-cell count, 15 100/mm3 with 80.1% segmented neutrophils), the rest of the analytic profile was normal (Table S1 in the online-only Data Supplement). Electrocardiography tracing on sinus rhythm was without signs of left ventricular hypertrophy or myocardial ischemia. Cerebral computed tomographic scan revealed bilateral hypodense lesions in …