Posterior reversible encephalopathy syndrome in a child with leptospira-associated glomerulonephritis: the 3 P’S framework

Posterior reversible encephalopathy syndrome (PRES) is an under-recognised cause of seizures in children, often obscured by concurrent infections. We report a girl in her middle childhood with recurrent seizures following a week of fever and flood exposure. Initial suspicion was leptospira encephalitis, supported by positive serology. However, progressive hypertension and CT brain findings confirmed PRES secondary to leptospira-associated acute glomerulonephritis. She improved with antihypertensives, antiepileptics and antibiotics, and was discharged seizure-free. This case highlights the risk of anchoring bias and introduces the ‘3 P’s of PRES’ framework—Pressure, Pattern and Pictures—for earlier recognition and management.