Cyclosporin A-induced encephalopathy after allogeneic bone marrow transplantation with prevention of graft-versus-host disease by tacrolimus.
A 21-year-old woman with severe aplastic anemia received an allogeneic bone marrow transplant (allo-BMT) from an HLA-matched and ABO-matched sibling donor after conditioning with cyclophosphamide, rabbit ATG (Lymphoglobuline; Aventis-Pharma), and total lymphoid irradiation. She had a long history of cyclosporin A (CsA) therapy before conditioning. She complained of severe headache and convulsions on day 0, and findings on magnetic resonance images suggested CsA-induced encephalopathy. CsA was immediately stopped, and tacrolimus for prevention of graft-versus-host disease (GVHD) was started on day 2. Hematological engraftment was observed on day 14 without serious GVHD. Prompt diagnosis, replacement of immunosuppressive agents, and careful monitoring of serum drug concentrations are thought to have contributed to the patient's good clinical course, since CsA-induced encephalopathy tends to be recurrent but to improve completely without any sequelae.
Takahata
M
M
Third Department of Internal Medicine, Hokkaido University School of Medicine, Kita-15, Nishi-7, Sapporo 060-8638, Japan.
Hashino
S
S
Izumiyama
K
K
Chiba
K
K
Suzuki
S
S
Asaka
M
M
D000328:Adult; D000741:Anemia, Aplastic / Q000188:drug therapy / Q000628:therapy*; D000927:Anticonvulsants / Q000627:therapeutic use; D001812:Blood-Brain Barrier / Q000187:drug effects; D016026:Bone Marrow Transplantation; D001927:Brain Diseases / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D001929:Brain Edema / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D002442:Ceftazidime / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D016572:Cyclosporine / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004232:Diuretics / Q000627:therapeutic use; D004730:Endothelium, Vascular / Q000187:drug effects; D004829:Epilepsy, Generalized / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D015725:Fluconazole / Q000009:adverse effects; D006086:Graft vs Host Disease / Q000517:prevention & control; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D016559:Tacrolimus / Q000627:therapeutic use; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D000927:Anticonvulsants; D004232:Diuretics; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D015725:Fluconazole; D002442:Ceftazidime; D016559:Tacrolimus