Posterior Reversible Encephalopathy Syndrome in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Case Report

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before coming to the hospital, and a history of drowsiness for 1 day.On admission to the emergency room, arterial blood gas analysis showed partially compensated respiratory acidosis, partial pressure of carbon dioxide of 96.6 mm Hg, pH of 7.331, and bicarbonate of 49.6.In the intensive care unit (ICU), the patient was intubated in view of a poor Glasgow coma score (GCS-E1M5V1); chest X-ray IntroductIonPosterior reversible encephalopathy syndrome (PRES) is characterized by headache, seizures, visual disturbances, and altered sensorium.It is associated with predisposing conditions such as chronic kidney disease, acute-on-chronic kidney disease, posttransplantation on immunosuppressive therapy, hypertension, and postpartum. 1 Patients in all age groups are at risk; there have been reported cases in patients ranging from 2 to 90 years of age.2,3 As the name might suggest, PRES is not only restricted to the posterior circulation territory; it can involve either the posterior and nonposterior circulation areas.4 Diagnosis of PRES is based on both clinical features and typical brain imaging findings.Although the condition is typically reversible, it is vital to diagnose and treat the condition early to prevent permanent brain damage.We present a case of a 61-year-old female with chronic obstructive pulmonary disease (COPD) exacerbation who developed the distinctive features of PRES. case descrIptIonThis was a case of a 61-year-old female, known COPD for the last 5 years.Her regular medications included deflazacort 6 mg once a day (OD), sildenafil 25 mg bis in die, Ambrisentan 5 mg OD, inhaled combination of (tiotropium bromide 9 μg, ciclesonide 200 μg, and formoterol 6 μg), and torsemide 10 mg OD.Relevant demographic information is depicted in Table 1.She was admitted to a tertiary care hospital in Pune with a 2-day history of fever, increasing breathlessness for 2 days, one episode of vomiting 1-4,7-

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