Asian Journal of Medical Research and Case Reports

Aims: We report an adolescent male with severe hypertensive encephalopathy and generalised tonic-clonic seizures as a rare and emergent paediatric complication occurring in the setting of suspected post-mumps acute glomerulonephritis (AGN).

Presentation of Case: A previously well 15-year-old adolescent male presented with a 7-day history of intermittent fever, progressive throbbing headache, intermittent non-bilious vomiting, visual blurring, and two generalised tonic-clonic seizures. He reported a history of tender bilateral parotitis 5–6 days earlier, which had regressed spontaneously. On presentation to the ED, he had a severe hypertensive crisis with a blood pressure (BP) of 180/104 mmHg (>99th percentile + 30 mmHg) and sinus bradycardia (52–55 bpm), with evidence of Cushing’s reflex. Examination revealed moderate periorbital facial puffiness without peripheral oedema. A non-contrast computed tomography scan of the brain showed no intracerebral haemorrhage or gross structural abnormality. Investigations showed 17–19 RBC/HPF on urinalysis, with dipstick blood 2+, microscopic haematuria, proteinuria, CRP 6.50 mg/L, and positive serum mumps IgM at 1:160, while serum creatinine (0.76 mg/dL) and urea (18 mg/dL) remained normal. Bilateral renal Doppler ultrasonography revealed structurally normal renal parenchyma with a normal resistive index (0.50–0.70) and no renal artery stenosis. On admission to the PICU, a continuous intravenous labetalol infusion was started (0.25 mg/kg/hr, titrated to achieve a 25% reduction in mean blood pressure over 6–8 hours), together with intravenous levetiracetam (20 mg/kg/day), mannitol, and furosemide to correct volume overload. His blood pressure and neurological condition improved within 48–72 hours, and he was subsequently discharged after transition to oral amlodipine (5 mg OD), without neurological or renal     sequelae.

Discussion: Acute post-streptococcal glomerulonephritis (APSGN) is the leading cause of post-infectious glomerulonephritis in children, but other infections, including viral infection with mumps paramyxovirus, have been associated with immune-complex endocapillary glomerulonephritis. Acute volume overload may exceed the brain’s vascular autoregulatory capacity, producing vasogenic oedema, hypertensive encephalopathy, and seizures, and warrants clinical awareness and careful differentiation from viral meningoencephalitis.

Conclusion and Clinical Outcome: The differential diagnosis of an acute hypertensive crisis and encephalopathy occurring after parotitis includes suspected post-mumps acute glomerulonephritis. Prompt PICU stabilisation with controlled intravenous labetalol administration, neuroprotection, and transition to oral antihypertensive therapy resulted in a favourable neurological and haemodynamic outcome.