Cyclosporine-related encephalopathy following allogeneic bone marrow transplantation.
A 46-year-old man with chronic myelogenous leukemia received allogeneic bone marrow transplantation (BMT) from a partially human leukocyte antigen (HLA)-mismatched sibling. Cyclosporine (CYA)-related encephalopathy developed on days 10 and 21 following BMT, and CYA-related thrombotic thrombocytopenic purpura (TTP) developed on day 45 following BMT. We measured serum concentrations of thrombomodulin (TM) as a marker of endothelial injury. The concentrations of TM were increased during the encephalopathy or TTP and decreased following recovery. Since CYA can cause endothelial injury, we suggest that CYA-induced endothelial injury is common to the pathogenesis of both the encephalopathy and the TTP. CYA therapy should be reinstituted with extreme caution in patients with a past history of CYA-related encephalopathy, since readministration of a low-dose CYA can evoke the immediate return of the encephalopathy.
Teshima
T
T
Department of Internal Medicine, Kitakyushu Municipal Medical Center, Fukuoka, Japan.
Miyoshi
T
T
Ono
M
M
D016026:Bone Marrow Transplantation; D001927:Brain Diseases / Q000139:chemically induced*; D016572:Cyclosporine / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D016572:Cyclosporine