Abstract
Tacrolimus is a calcineurin inhibitor and has been proven highly effective in preventing graft rejection after transplantation of solid organs. Its major adverse effects are nephrotoxicity and neurotoxicity: the most severe form of the latter is PRES (Posterior Reversible Encephalopathy Syndrome).
We here describe a case of PRES in a 26-year-old woman, 5 days after she received bilateral lung transplantation for cystic fibrosis. She had been administered tacrolimus since the transplantation was performed. While in ICU, she suddenly developed mental status alterations, acute pulmonary deterioration and hypercapnia, with need of mechanical ventilation. A head CT scan and MR were performed, detecting subcortical white matter lesions and patchy, bilaterally symmetric areas of abnormally increased signal on the T1-weighted images within the cerebellum and the occipital-parietal and frontal regions of the brain; a minor alteration was also present in the thalamus. ADC (i.e. Apparent Diffusion Coefficients) mapping showed wide areas of vasogenic and cytotoxic edema.
Tacrolimus was immediately stopped and cyclosporine was introduced: her symptoms promptly improved.
A MRI was repeated two weeks later, documenting a significant improvement both of the cerebellum and the thalamus.
A follow up MRI was performed two months after the transplantation: prior lesions had almost completely resolved.
She still suffers from minor neuro-cognitive deficits (concerning calculus and short-term memory) and visual disturbances.
This case maybe significant in order to better understand the clinical features of PRES, which may present at a very early stage of tacrolimus regimen and is a generally reversible condition.
- © 2011 ERS
