title: Reversible acute encephalopathy with mutism, induced by calcineurin inhibitors after renal transplantation.
abstract: The incidence of neurotoxicity from calcineurin inhibitors varies by the organ transplanted. Akinetic mutism is characterized by the inability to perform voluntary movements and express language, without alterations in mental status. This process has been reported in neurotoxicity due to high serum levels of calcineurin inhibitors, but in rare cases, it presents as a form of tacrolimus toxicity after renal transplantation, despite normal serum levels. We report a clinical case of a renal transplant patient in whom reversible acute encephalopathy and akinetic mutism developed. Brain lesions appeared on magnetic resonance imaging, and the condition resolved after the drug was withdrawn.
authors.affiliation: Department of Nephrology, Reina Sofía University Hospital, Córdoba, Spain. katia.toledo.perdomo@gmail.com
authors.forename: Katia
authors.initials: K
authors.lastname: Toledo Perdomo
authors.forename: María-Dolores
authors.initials: MD
authors.lastname: Navarro Cabello
authors.forename: María-José
authors.initials: MJ
authors.lastname: Pérez Sáez
authors.forename: Manuel José
authors.initials: MJ
authors.lastname: Ramos Pérez
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Agüera Morales
authors.forename: Pedro
authors.initials: P
authors.lastname: Aljama García
mesh_terms: D000405:Akinetic Mutism / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D001921:Brain / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D065095:Calcineurin Inhibitors; D057915:Drug Substitution; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009460:Neurologic Examination; D020258:Neurotoxicity Syndromes / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D016559:Tacrolimus / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus; D016559:Tacrolimus