Posterior Reversible Encephalopathy Syndrome in a Young Female with Takayasu and Tubercular Arteritis: A Rare Case Report

ABSTRACT: Tuberculosis (TB) may co-occur with Takayasu arteritis (TA), a large vessel vasculitis, thus complicating the management, particularly in endemic areas. We report the case of a 17-year-old female who presented with severe headache, blurred vision, giddiness, seizures, syncope, and hypertensive urgency (200/110 mmHg). Renal Doppler demonstrated left renal artery stenosis (RAS), and magnetic resonance imaging showed posterior reversible encephalopathy syndrome (PRES). TA was suggested by raised inflammatory markers (erythrocyte sedimentation rate: 70 mm/h, C-reactive protein: 212 mg/L) and computed tomography aortography illustrating left RAS and circumferential wall thickening of the descending aorta. Co-infection with TB was suggested by the presence of calcified lymph nodes. On treatment with antihypertensives, anti-TB therapy, and corticosteroids, the patient improved symptomatically and was discharged with ongoing treatment. Our case emphasizes the significance of considering TB and TA in young females who present with renovascular hypertension and PRES, thus highlighting the role of inflammatory markers and imaging in early diagnosis and treatment.