Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

A case of tacrolimus-induced encephalopathy after kidney transplantation

  • Kim, Myoung-Uk (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Kim, Sae-Yoon (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Son, Su-Min (Department of Physical Medicine & Rehabilitation, College of Medicine, Yeungnam University) ;
  • Park, Yong-Hoon (Department of Pediatrics, College of Medicine, Yeungnam University)
  • 투고 : 2010.09.15
  • 심사 : 2010.10.20
  • 발행 : 2011.01.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

We present a case of tacrolimus-induced encephalopathy after successful kidney transplantation. An 11-year-old girl presented with sudden onset of neurologic symptoms, hypertension, and psychiatric symptoms, with normal kidney function, after kidney transplantation. The symptoms improved after cessation of tacrolimus. Magnetic resonance imaging (MRI) showed acute infarction of the middle cerebral artery (MCA) territory in the right frontal lobe. Three days later, she had normal mental function and maintained normal blood pressure with left hemiparesis. Follow-up MRI was performed on D19, showing new infarct lesions at both cerebral hemispheres. Ten days later, MRI showed further improvement, but brain single photon emission computed tomography (SPECT) showed mild reduction of uptake in both the anterior cingulate gyrus and the left thalamus. One month after onset of symptoms, angiography showed complete resolution of stenosis. However, presenting as a mild fine motor disability of both hands and mild dysarthria, what had been atrophy at both centrum semiovale at 4 months now showed progression to encephalomalacia. There are two points of interest in this case. First, encephalopathy occurred after administration of tacrolimus and improved after discontinuation of the drug. Second, the development of right-side hemiplegia could not be explained by conventional MRI; but through diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) of white matter tract, visualization was possible.

키워드

참고문헌

  1. Bartynski WS, Boardman JF. Catheter angiography, MR angiography, and MR perfusion in posterior reversible encephalopathy syndrome. Am J Neuroradiol 2008;29:447-455. https://doi.org/10.3174/ajnr.A0839
  2. Ishikura K, Ikeda M, Hamasaki Y, Hataya H, Shishido S, Asanuma H, et al. Posterior reversible encephalopathy syndrome in children: its high prevalence and more extensive imaging findings. Am J Kidney Dis 2006;48:231-238. https://doi.org/10.1053/j.ajkd.2006.04.076
  3. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500. https://doi.org/10.1056/NEJM199602223340803
  4. Hodnett P, Coyle J, O'Regan K, Maher MM, Fanning N. PRES (posterior reversible encephalopathy syndrome), a rare complication of tacrolimus therapy. Emerg Radiol 2009;16:493-496. https://doi.org/10.1007/s10140-008-0782-6
  5. Ikeda M, Ito S, Hataya H, Honda M, Anbo K. Reversible posterior leukoencephalopathy in a patient with minimal-change nephrotic syndrome. Am J Kidney Dis 2001;37:E30. https://doi.org/10.1016/S0272-6386(01)90016-2
  6. Ikeda M, Yata N, Kamei K, Mori K, Ishikura K, Hataya H, et al. Posterior leukoencephalopathy syndrome in pediatric patients with kidney disease. Pediatr Nephrol 2002;17:71. https://doi.org/10.1007/s004670200013
  7. Parvex P, Pinsk M, Bell LE, O'Gorman AM, Patenaude YG, Gupta IR. Reversible encephalopathy associated with tacrolimus in pediatric renal transplants. Pediatr Nephrol 2001;16:537-542. https://doi.org/10.1007/s004670100602
  8. Prasad N, Gulati S, Gupta RK, Kumar R, Sharma K, Sharma RK. Is reversible posterior leukoencephalopathy with severe hypertension completely reversible in all patients? Pediatr Nephrol 2003;18:1161-1166. https://doi.org/10.1007/s00467-003-1243-9
  9. Casey SO, Truwit CL. Pontine reversible edema: a newly recognized imaging variant of hypertensive encephalopathy? Am J Neuroradiol 2000;21:243-245.
  10. Singh N, Bonham A, Fukui M. Immunosuppressive-associated leukoencephalopathy in organ transplant recipients. Transplantation 2000; 69:467-472. https://doi.org/10.1097/00007890-200002270-00001
  11. Kwon S, Koo K, Lee S. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Pediatr Neurol 2001;24:361-364. https://doi.org/10.1016/S0887-8994(01)00265-X
  12. Lamy C, Oppenheim C, Meder JF, Mas JL. Neuroimaging in posterior reversible encephalopathy syndrome. J Neuroimaging 2004;14:89-96. https://doi.org/10.1111/j.1552-6569.2004.tb00223.x
  13. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000;356: 411-417. https://doi.org/10.1016/S0140-6736(00)02539-3
  14. Schwartz RB, Feske SK, Polak JF, DeGirolami U, Iaia A, Beckner KM, et al. Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology 2000;217:371-376. https://doi.org/10.1148/radiology.217.2.r00nv44371
  15. Onder AM, Lopez R, Teomete U, Francoeur D, Bhatia R, Knowbi O, et al. Posterior reversible encephalopathy syndrome in the pediatric renal population. Pediatr Nephrol 2007;22:1921-1929. https://doi.org/10.1007/s00467-007-0578-z
  16. Kemper MJ, Sparta G, Laube GF, Miozzari M, Neuhaus TJ. Neuropsychologic side-effects of tacrolimus in pediatric renal transplantation. Clin Transplant 2003;17:130-134. https://doi.org/10.1034/j.1399-0012.2003.00028.x
  17. Schwartz RB. Hyperperfusion encephalopathies: hypertensive encephalopathy and related conditions. Neurologist 2002;8:22-34. https://doi.org/10.1097/00127893-200201000-00003
  18. Abe K. Reversible posterior leukoencephalopathy syndrome. Intern Med 2004;43:900-901. https://doi.org/10.2169/internalmedicine.43.900
  19. Furukawa M, Terae S, Chu BC, Kaneko K, Kamada H, Miyasaka K. MRI in seven cases of tacrolimus (FK-506) encephalopathy: utility of FLAIR and diffusion-weighted imaging. Neuroradiology 2001;43:615- 621. https://doi.org/10.1007/s002340100545
  20. Akutsu N, Iwashita C, Maruyama M, Ootsuki K, Ito T, Saigo K, et al. Two cases of calcineurin inhibitor-associated reversible posterior leukoencephalopathy syndrome in renal transplant recipients. Transplant Proc 2008;40:2416-2418. https://doi.org/10.1016/j.transproceed.2008.07.104
  21. Emiroglu R, Ayvaz I, Moray G, Karakayali H, Haberal M. Tacrolimusrelated neurologic and renal complications in liver transplantation: a single-center experience. Transplant Proc 2006;38:619-621. https://doi.org/10.1016/j.transproceed.2005.12.114
  22. Nguyen TH, Yoshida M, Stievenart JL, Iba-Zizen MT, Bellinger L, Abanou A, et al. MR tractography with diffusion tensor imaging in clinical routine. Neuroradiology 2005;47:334-343. https://doi.org/10.1007/s00234-005-1338-z
  23. Huppi PS, Dubois J. Diffusion tensor imaging of brain development. Semin Fetal Neonatal Med 2006;11:489-497. https://doi.org/10.1016/j.siny.2006.07.006
  24. Johansen-Berg H, Behrens TE. Just pretty pictures? What diffusion tractography can add in clinical neuroscience. Curr Opin Neurol 2006; 19:379-385. https://doi.org/10.1097/01.wco.0000236618.82086.01

피인용 문헌

  1. Calcineurin Inhibitor Induced Multiple Infarctions vol.30, pp.4, 2016, https://doi.org/10.4285/jkstn.2016.30.4.190