Progressive necrotic encephalopathy following tacrolimus therapy for liver transplantation.
Previously described neurologic damage induced by immunosuppressive treatments includes transient or reversible central nervous system involvement. We describe a 57-year-old man who underwent liver transplantation and was started on immunosuppressive therapy with tacrolimus (FK506). Six months later, he started complaining of a progressive motor and sensory impairment of the left side, together with cognitive impairment. Brain MRI showed an enlarging lesion of the white matter with peripheral contrast enhancement. PET study indicated severe hypometabolism in the right hemisphere and spectroscopic MRI showed a peak of choline and relative reduction of other metabolites. Findings of CSF examinations and cultures, serology, and molecular techniques were normal. Tacrolimus treatment was stopped. A cerebral biopsy of the lesion showed a sub acute necrotizing process. In the following months, cognitive status of the patient tended to improve although he remained hemiplegic, while serial MRI confirmed the tendency to the recovery of the lesion that was still present 1 year after. The present observation describes a progressive encephalopathy associated with immune suppression with an unusual feature and permanent brain damage.
Aridon
Paolo
P
Department of Clinical Neuroscience, University of Palermo, Via Gaetano La Loggia 1, 90129 Palermo, Italy.
Ragonese
Paolo
P
Di Benedetto
Norma
N
Grasso
Giovanni
G
Conaldi
Pier Giulio
PG
D'Amelio
Marco
M
Savettieri
Giovanni
G
D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D001927:Brain Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D018450:Disease Progression; D005500:Follow-Up Studies; D006521:Hepatitis, Chronic / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000379:methods*; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D049268:Positron-Emission Tomography; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use*; D044465:White People
D007166:Immunosuppressive Agents; D016559:Tacrolimus