Reversible posterior leukoencephalopathy syndrome after blood transfusion in a pediatric patient with sickle cell disease.

Background: Children with sickle cell disease are at increased risk for neurological complications. Reversible posterior leukoencephalopathy syndrome is a clinico-radiological syndrome characterized by headache, vomiting, seizures, and visual disturbances along with the radiological findings of posterior leukoencephalopathy.

Methods: We report a 13-year-old female with sickle cell disease presenting with a headache and two isolated episodes of partial seizures with secondary generalization after blood transfusion. The brain MRI revealed bilateral high signal areas on T2 images in parietal, occipital, and frontal lobes; in the cerebellum; midbrain; and within the right caudate nucleus. Follow-up MRI 2 weeks later showed almost complete resolution of the previously detected findings. The clinical presentation along with the reversible aforementioned neuroimaging findings indicated reversible posterior leukoencephalopathy syndrome as the most appropriate diagnosis. Although the syndrome has been described previously in various clinical conditions, this is the first time that it is recognized after blood transfusion in an adolescent with sickle cell disease.

Conclusions: Neurological deterioration in children with sickle cell disease after blood transfusion should raise high suspicion for reversible posterior leukoencephalopathy syndrome, especially in the setting of elevated blood pressure.