Concurrent transfusion-related acute lung injury and posterior reversible encephalopathy: A rare multisystem imaging presentation

Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated morbidity and mortality. Posterior reversible encephalopathy syndrome (PRES) following transfusion is uncommon, and its concurrent occurrence with TRALI has rarely been described in the literature. We report a 65-year-old male with ascending colon carcinoma status post right hemicolectomy on adjuvant chemotherapy who developed acute hypoxemia and bilateral pulmonary infiltrates within 3 hours of packed red blood cell transfusion, consistent with TRALI. He subsequently developed acute neuropsychiatric manifestations, including agitation, headache, visual disturbances, abnormal behavior, nystagmoid eye movements, and gaze deviation. Magnetic resonance imaging demonstrated bilateral frontoparietal vasogenic edema without diffusion restriction, consistent with PRES. Both pulmonary and neurological abnormalities resolved substantially on follow-up. No pulmonary or neurological deficits were detected in sequential monthly follow-ups. Alternative causes, including transfusion-associated circulatory overload, sepsis-related acute respiratory distress syndrome, and sepsis-associated encephalopathy, were considered and are discussed. This case highlights the importance of recognizing rare, overlapping pulmonary and neurological transfusion complications and considering confounding illness in their diagnosis.