Early tacrolimus administration induced encephalopathy in a renal transplanted patient; a case report

Abstract

Neurotoxicity due to CNI (calcineurin inhibitors; cyclosporine or tacrolimus) is common after organ transplantation and associated with significant morbidity and mortality. Early identification of drug induced neurotoxicity in transplanted patients is important. We report a 45 year-oldwoman who had undergone kidney transplantation and after 24 hours while she suffered from blurred vision and severe headache that did not respond to analgesic drugs. She was administered tacrolimus, prednisone, mycophenolate and anti-thymocyte globulin. Neurologic examination revealed subjective homonymous hemianopia without focal deficit. Other laboratory tests and brain magnetic resonance imaging (MRI) were normal. There was not any evidence of infections, metabolic and neoplastic diseases. Diagnosis of posterior reversible encephalopathy syndrome (PRES) was made by clinical finding. Tacrolimus was withdrawn 2 days after administration and replaced by cyclosporine. Clinical symptoms were resolved 4 days after discontinuation of tacrolimus.

Keywords

• Tacrolimus
• Encephalopathy
• Neurotoxicity
• Transplantation
• Calcineurin inhibitor