Korean J Nephrol.  2010 Mar;29(2):305-309.

A Case of Reversible Posterior Leukoencephalopathy Syndrome in a Patient with ABO Incompatible Kidney Transplantation

• Kim JI
• Choi AS
• Kim SJ
• Ji BH
• Oh JS
• Son YK
• Shin YH
• Kim JK

Abstract

Reversible posterior leukoencepalopathy syndrome (RPLS) was noted by a reversible syndrome of headache, altered mental status, seizure, and visual loss associated with findings indicating predominantly posterior leukoencephalopathy on imaging studies. We report a successful treatment of RPLS after secondary ABO incompatibility kidney transplantation with blood pressure control. A 41-year-old female whose primary kidney disease was chronic glomerulonephritis had graft failure developed after living donor kidney transplantation (1st kidney transplantation). She was admitted to our hospital for 2nd ABO incompatibility kidney transplantation. She had undergone 6 times of plasmapheresis and received additional two doses of rituximab (375 mg/m2) and intravenous immunoglobulin (0.5 g/kg) before kidney transplantation. She received basiliximab induction therapy, tacrolimus, steroid and mycophenolate mofetile after transplantation. The ABO antibody titer had been low (below 1:1) and evidences of rejection were not detected. Generalized tonic clonic type seizure, eyeball deviation, facial cyanotic change and loss of consciousness occurred at post operation 7th day. Several minutes later, she recovered her consciousness without disability and neurologic deficit. She did not represent attacks any more after we controlled blood pressure without withdrawal of immunosuppressants or dose reduction.

Keyword

Reversible posterior leukoencephalopathy syndrome; Kidney transplantation

MeSH Terms

Adult
Antibodies, Monoclonal
Antibodies, Monoclonal, Murine-Derived
Blood Pressure
Consciousness
Female
Glomerulonephritis
Headache
Humans
Immunoglobulins
Immunosuppressive Agents
Kidney
Kidney Diseases
Kidney Transplantation
Leukoencephalopathies
Living Donors
Neurologic Manifestations
Plasmapheresis
Posterior Leukoencephalopathy Syndrome
Recombinant Fusion Proteins
Rejection (Psychology)
Seizures
Tacrolimus
Transplants
Unconsciousness
Rituximab
Antibodies, Monoclonal
Antibodies, Monoclonal, Murine-Derived
Immunoglobulins
Immunosuppressive Agents
Recombinant Fusion Proteins
Tacrolimus