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POSTERIOR REVERSIBLE LEUKOENCEPHALOPATHY SYNDROME IN A CHILD ON CAPD

A 14-year-old girl with Bardett–Biedel syndrome was admitted 2 years back in to our hospital with nausea, vomiting and anasarca. She was born to a consanguineously married couple and is the first of three siblings. On evaluation she was found to have severe azotemia and small contracted kidneys. She was given acute peritoneal dialysis for 2 days and discharged at request. She developed pre-peritoneal abscess, which was drained, and antibiotics were given. Three months later, she was readmitted with seizures and altered sensorium because of azotemia. She was given three sessions of haemodialysis and later initiated on CAPD. Since then she was doing well on three exchanges (2.27%, Claris) per day of CAPD. She was on losartan (50 mg, once a day) and Erythropoetin (2000 IU/twice a week) and not given any calcium supplements because of gastric intolerance. She had one episode of culture negative peritonitis 4 months prior to this present admission and was successfully treated with vancomycin and amikacin. She was admitted in October 2006 with history of two episodes of seizures and altered sensorium. There was no history of fever, vomiting or weakness of limbs. She skipped her daily CAPD exchanges for 2 days before the admission. At the time of admission, she was drowsy, arousable; pulse rate was 98/min; blood pressure was 130/80 mm Hg. She had pallor and there was no lymphadenopathy. There was no focal neurological deficit. The investigations revealed blood urea – 240 mg/dL; serum creatinine – 9.8 mg/dL; Sodium – 142 meq/L; Potassium – 4.2 meq/L; Calcium – 5.8 mg/d (corrected – 7.8 gm/dL); Phophorus – 5.2 mg/dL; Magnesium – 1 mg/dL; total serum protein – 6 gm/dL; serum albumin – 2 gm/dL. CT scan of the brain did not reveal any major abnormality. A magnetic resonance imaging scan (Figs. 1 and 2) revealed abnormalities in the posterior regions of the cerebral hemisphere and was suggestive of posterior leucoenkephalopathy. She was given her daily exchanges of CAPD and treated with Phenytoin. She has improved significantly after few hours. Phenytoin was stopped after a week and she is asymptomatic during 1 year of follow-up.