Successful treatment of tacrolimus (FK506)-related leukoencephalopathy with cerebral hemorrhage in a patient who underwent nonmyeloablative stem cell transplantation.
A 46-year-old woman with Hodgkin's disease who underwent nonmyeloablative allogeneic stem cell transplantation developed cortical blindness, seizures, and left hemiparesis on day 100 while receiving tacrolimus (FK506) and prednisone for the treatment of graft-versus-host disease (GVHD). Magnetic resonance imaging revealed multiple changes, mainly in the bilateral occipital lobes, suggesting FK506-related leukoencephalopathy. These abnormalities improved after discontinuation of FK506. However, 3 days after the episode, cerebral hemorrhage in the left occipital lobe with perforation to the left subdural space occurred. Although FK506-induced leukoencephalopathy with cerebral hemorrhage is considered the more severe form of such leukoencephalopathy, the patient's neurological symptoms almost completely resolved and radiographic findings improved after discontinuation of FK506, tapering of methylprednisolone, and initiation of mycophenolate mofetil. FK506-related leukoencephalopathy is a rare complication after allogeneic stem cell transplantation. Although the symptoms usually subside after discontinuation of FK506, therapeutic intervention in many cases may result in severe complications, including GVHD and vascular disease. We consider it important to use immunosuppressive agents without vascular endothelial toxicity for preventing the development of fatal GVHD after discontinuation of FK506.
Tamaki
Hiroya
H
Department of Molecular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Kawakami
Manabu
M
Ikegame
Kazuhiro
K
Iio
Kenichiro
K
Harada
Yu
Y
Hatanaka
Kazuo
K
Oka
Yoshihiro
Y
Kawase
Ichiro
I
Ogawa
Hiroyasu
H
D002543:Cerebral Hemorrhage / Q000209:etiology*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy; D006689:Hodgkin Disease / Q000150:complications / Q000628:therapy; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D012074:Remission Induction / Q000379:methods; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects*; D019172:Transplantation Conditioning / Q000379:methods
D016559:Tacrolimus