J Korean Soc Transplant.  2016 Dec;30(4):190-193. 10.4285/jkstn.2016.30.4.190.

Calcineurin Inhibitor Induced Multiple Infarctions

Affiliations
  • 1Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea. bellokim1@gmail.com

Abstract

Tacrolimus is the most commonly used immunosuppressant after kidney transplantation. Here, we report a patient with multiple cerebral infarctions during tacrolimus treatment after kidney transplantation. A 54-year-old female was admitted due to sudden onset right leg weakness. Brain magnetic resonance imaging (MRI) showed multiple acute infarctions but normal vasculature. Evaluations of cardiac embolism were unremarkable. After 8 months, her weakness progressed and follow-up brain MRI showed additional multiple infarctions. We changed here medication from tacrolimus to mycophenolate mofetil, and her symptoms improved gradually.

Keyword

Tacrolimus; Acute cerebral infarction; Kidney transplantation

MeSH Terms

Brain
Calcineurin*
Cerebral Infarction
Embolism
Female
Follow-Up Studies
Humans
Infarction*
Kidney Transplantation
Leg
Magnetic Resonance Imaging
Middle Aged
Tacrolimus
Calcineurin
Tacrolimus

Figure

  • Fig. 1. Initial magnetic resonance imaging (MRI) including (A) diffusion-weighted sequence and (B) susceptibility-weighted sequence shows multiple infarctions involving bilateral corona radiata. (C) Enhanced T1-weighted image and (D) intracranial angiography are normal. Follow-up MRI on re-admission shows (E) recurred acute infarctions involving brain stem and bilateral subcortical white matters from diffusion-weighted sequence and (F) increased white matter changes from fluid attenuated inversion recovery sequence.


Reference

1. Kim Y, Lee SH, Lee DW, Jung H, Oh TS, Kim MJ, et al. Posterior reversible encephalopathy syndrome improved by changing immunosuppressant from calcineurin inhibitor to sirolimus in a kidney transplantation recipient. J Korean Soc Transplant. 2015; 29:166–9.
Article
2. Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V, et al. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol. 2010; 64:169–177.
Article
3. Chegounchi M, Hanna MG, Neild GH. Progressive neurological disease induced by tacrolimus in a renal transplant recipient: case presentation. BMC Nephrol. 2006; 7:7.
Article
4. Senzolo M, Ferronato C, Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009; 22:269–278.
5. Kim MU, Kim SY, Son SM, Park YH. A case of tacrolimus-induced encephalopathy after kidney transplantation. Korean J Pediatr. 2011; 54:40–44.
Article
6. Imataki O, Uemura M, Shintani T, Matsumoto K. Reversible cerebral vasoconstriction syndrome resulted in cerebral infarction after allogeneic stem cell transplantation: a case report. Ann Hematol. 2014; 93:895–896.
Article
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