J Korean Soc Transplant.  2015 Sep;29(3):166-169. 10.4285/jkstn.2015.29.3.166.

Posterior Reversible Encephalopathy Syndrome Improved by Changing Immunosuppressant from Calcineurin Inhibitor to Sirolimus in a Kidney Transplantation Recipient

• Kim Y
• Lee SH
• Lee DW
• Jung H
• Oh TS
• Kim MJ
• Kang JY
• Kang SW
• Kim YH

• KMID: 2202589
• DOI: http://doi.org/10.4285/jkstn.2015.29.3.166

Abstract

Posterior reversible encephalopathy syndrome (PRES) is neurotoxicity characterized by brain imaging findings of reversible subcortical vasogenic edema. Clinical manifestations include seizure, altered mental status, focal neurologic deficit, and headache. Tacrolimus, a potent immunosuppressant, is related to increased risk of PRES in transplantation recipients. We report on a case of PRES in a 48-year-old female kidney transplantation recipient who received immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone. On postoperative day 14, she complained of moderate to severe headache which did not respond to usual analgesics. Magnetic resonance imaging showed high signal intensity on T2-weighted images and fluid-attenuated inverse recovery imaging in both parieto-occipital areas. The condition was improved after changing immunosuppressant from tacrolimus to sirolimus.

Keyword

Posterior leukoencephalopathy syndrome; Calcineurin inhibitors; Sirolimus; Kidney transplantation

MeSH Terms

Analgesics
Calcineurin*
Edema
Female
Headache
Humans
Immunosuppression
Kidney Transplantation*
Kidney*
Magnetic Resonance Imaging
Middle Aged
Neuroimaging
Neurologic Manifestations
Posterior Leukoencephalopathy Syndrome*
Prednisolone
Seizures
Sirolimus*
Tacrolimus
Analgesics
Calcineurin
Prednisolone
Sirolimus
Tacrolimus

Figure

• 

  Fig. 1. Brain magnetic resonance imaging showed high signal intensity at subcortical white matter of both parieto-occipital lobes in (A) T2-weighted image and (B) fluid-atte-nuated inverse recovery imaging.

• 

  Fig. 2. Repeated brain magnetic resonance imaging taken 5 weeks later showed resolution of previously noted both parieto-occipital signal change in (A) T2-weighted image and (B) fluid-attenuated inverse recovery imaging.

Reference

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