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This case report discusses a 14-year-old male who developed posterior reversible encephalopathy syndrome (PRES) during the recovery phase of severe leptospirosis, characterized by acute kidney injury and pulmonary hemorrhage. The patient presented with altered consciousness and seizures, with MRI revealing symmetrical white matter changes consistent with PRES. The report highlights the interplay of various pathophysiological mechanisms leading to PRES in leptospirosis and emphasizes the importance of recogn

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