Late fulminant posterior reversible encephalopathy syndrome after liver transplant.
OBJECTIVE
Posterior leukoencephalopathy due to calcineurin-inhibitor-related neurotoxicity is a rare but severe complication that results from treatment with immunosuppressive agents (primarily those administered after a liver or kidney transplant). The pathophysiologic mechanisms of that disorder remain unknown.


METHODS
We report the case of a 46-year-old woman who received a liver transplant in our center as treatment for alcoholic cirrhosis and in whom either a fulminant course of posterior leukoencephalopathy or posterior reversible encephalopathy syndrome developed 110 days after transplant. After an initially uneventful course after the transplant, the patient rapidly fell into deep coma.


RESULTS
Cerebral MRI scan showed typical signs of enhancement in the pontine and posterior regions. Switching the immunosuppressive regimen from tacrolimus to cyclosporine did not improve the clinical situation. The termination of treatment with any calcineurin inhibitor resulted in a complete resolution of that complication.


CONCLUSIONS
Posterior reversible encephalopathy syndrome after liver transplant is rare. We recommend a complete cessation of any calcineurin inhibitor rather than a dose reduction.
Heidenhain
Christoph
C
Klinik fur Allgemein-, Viszeral- und Transplantschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany. christoph.heidenhain@charite.de
Puhl
Gero
G
Neuhaus
Peter
P
D065095:Calcineurin Inhibitors; D003128:Coma / Q000139:chemically induced; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D016559:Tacrolimus / Q000009:adverse effects*; D013997:Time Factors
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus