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Malignant hypertension and interferon-beta: a case report

Journal of Human Hypertension volume 28, pages 340–341 (2014)Cite this article

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On 23 May 2012, a 41-year-old patient was admitted to hospital following a convulsive episode and severe hypertension. She had been treated for multiple sclerosis by interferon-beta since 2002. Her usual blood pressure (BP) values were unknown. She did not have any other cardiovascular risk factors. On admission to the emergency unit her BP was 220/140 mm Hg, and she was in a convulsive state. On initial evaluation, there was hemolysis, low serum potassium (3.2 mmol l−1), secondary hyperaldosteronism, and an elevation of cardiac, hepatic and pancreatic enzymes (Table 1). The electrocardiogram and the echocardiography were normal. There was no evidence of renal artery stenosis on Doppler echography, and adrenals, liver and pancreas were normal on computed tomography scan. Magnetic resonance imaging (MRI) of the brain showed ‘posterior regressive encephalopathy syndrome’ (PRES), and on fundal examination there was grade III hypertensive retinopathy. The patient was admitted to the intensive care unit and required intubatation and ventilation. Interferon-beta was stopped and she was given nicardipine IV to control BP, but the hemolysis persisted with worsening renal function. After extubation on 26 May she was started on bisoprolol. After the acute phase, the patient was transferred to the kidney unit on 05/06/2012. Blockers of the renin–angiotensin aldosterone system were titrated (progressive introduction of ramipril up to 10 mg per day followed by irbesartan up to 300 mg per day along with atenolol 100 mg per day). Amlodipine 10 mg was then administered reducing the BP below 140/90 mm Hg; all biologic parameters were normalized in 4 weeks (Table 1).

Table 1 Laboratory test data of our patient
Full size table

After 2 months of treatment the results were encouraging: ambulatory blood pressure measurements over 24 h: 137/87 mm Hg, creatinine 68 μmol/l. The lesions of PRES had disappeared on repeat MRI.

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Authors and Affiliations

  1. Renal Unit, Hôpital de la Côte Basque, Bayonne, France

    S Rubin, A Lacraz & V Galantine

  2. Cardiology and Hypertension, Hopital Saint André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    P Gosse

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  1. S Rubin
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  2. A Lacraz
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Correspondence to S Rubin.

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Rubin, S., Lacraz, A., Galantine, V. et al. Malignant hypertension and interferon-beta: a case report. J Hum Hypertens 28, 340–341 (2014). https://doi.org/10.1038/jhh.2013.91

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