Central pontine myelinolysis: a case report and clinical-pathological review.
An 11-yr-old child presented with acute mental status changes and spastic quadriplegia after orthotopic liver transplantation. Magnetic resonance (MR) imaging findings were consistent with central pontine and EPM. Initial immunosuppression included tacrolimus, mycophenolate mofetil, and corticosteroids. Given that neurotoxicity is a well-established side effect of CNI, the patient was converted to rapamycin and subsequently experienced significant neurologic recovery. The temporal resolution of the patient's symptoms suggests that prompt recognition of central pontine and EPM and conversion from tacrolimus to rapamycin during the early post-operative course may have therapeutic benefits for patients undergoing pediatric transplant with CNI-related neurotoxicity.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Rosa.Cui@uphs.upenn.edu
Rosa
R
Cui
Sameh
S
Fayek
Elizabeth B
EB
Rand
Tamara
T
Feygin
Dmitry
D
Khrichenko
Abraham
A
Shaked
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D001921:Brain / Q000473:pathology; D065095:Calcineurin Inhibitors; D002648:Child; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D017093:Liver Failure / Q000150:complications / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D017590:Myelinolysis, Central Pontine / Q000175:diagnosis* / Q000209:etiology*; D020123:Sirolimus / Q000627:therapeutic use*; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus