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Case Report
Tacrolimus-associated posterior reversible encephalopathy syndrome after kidney transplantation
1 Senior Resident, Department of Neurosurgery, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
2 Assistant Professor, Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
3 Associate Professor, Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
4 Head Physician, Department of Neurosurgery, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
5 Director, Department of Neurosurgery, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
6 Professor, Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
Address correspondence to:
Masatoshi Takagaki
MD, PhD, Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871,
Japan
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Article ID: 101297Z01TI2022
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Ishiuchi T, Takagaki M, Nakamura H, Morris S, Sakaki T, Kishima H. Tacrolimus-associated posterior reversible encephalopathy syndrome after kidney transplantation. Int J Case Rep Images 2022;13:101297Z01TI2022.ABSTRACT
Calcineurin inhibitors are essential immunosuppressive agents for kidney transplant patients. Posterior reversible leukoencephalopathy syndrome is a rare complication of treatment with calcineurin inhibitors. Herein, we report three cases of tacrolimus-associated posterior reversible leukoencephalopathy syndrome after kidney transplantation and their unique clinical courses. Patients in Cases 1 and 2 presented with headache and visual field disturbance on the fourth day after transplantation. Both patients were successfully treated with antihypertensive therapy and a change in medications from tacrolimus to cyclosporine and everolimus. Case 3 was a kidney transplant patient at 12 years post-transplant who developed fever and conjugate eye deviation to the right. The patient was initially treated with antihypertensive medication and a reduction in tacrolimus dose, but she experienced prolonged disturbance of consciousness, which eventually improved. These cases highlight the importance of considering the possibility of posterior reversible leukoencephalopathy syndrome in kidney transplant recipients taking calcineurin inhibitors who present with acute neurological dysfunction. They also demonstrate the need to perform appropriate imaging to confirm the diagnosis and initiate treatment, even if a significant amount of time has passed since transplantation. The introduction of an mTOR inhibitor may be practical when changing or discontinuing calcineurin inhibitors.
Keywords: Calcineurin inhibitors, Kidney transplantation, PRES, Tacrolimus
SUPPORTING INFORMATION
Author Contributions
Takamasa Ishiuchi - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Masatoshi Takagaki - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Hajime Nakamura - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Shayne Morris - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Takayuki Sakaki - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Haruhiko Kishima - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Takamasa Ishiuchi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
