Tacrolimus toxicity mimicking Progressive Multifocal Leucoencaphalopathy in renal transplant patient
ABSTRACT:
Tacrolimus is an immunosuppressive drug prescribed to many transplant patients. It has many common side effects include shaking, headache, diarrhea, constipation, nausea/vomiting (N/V), stomach upset, loss of appetite, insomnia, tingling and swelling of the extremities. In kidney transplant patients, 30% or more side effects are infection, HTN, abnormal renal function, constipation, diarrhea, N/V and insomnia. A very rare disease which is usually presented in Tacrolimus induced immunodeficiency is Progressive Multifocal Leucoencaphalopathy (PML).
We came across one such case which was initially suspected PML in 51 year old kidney …show more content…
The changes may be very subtle. It has been suggested that the less frequency grey matter pathology can be visualized better using MRI with FLAIR.FIG ()
These finding however are not specific, can be identical to those hypertensive encephalopathy. 16 such pts were identified with similar MRI findings were improved after BP control. This may also suggest synergic effect of all these cause leukoencephalopathy, which need further work up and confirmation.
CSF analysis in tacrolimus toxicity may be normal or these may be slight elevation of protein concentration. In our patient there were lymphocytic elevation and slight protein elevation, which was considered viral infection but later viral serology was reported negative.
Neuropathology in tacrolimus leukoencephalopathy shows cortical and subcortical infarcts,areas of diffuse neuronal necrosis,coagulative necrosis containing numerous macrophages,neutrophilic invasion of small cortical arteries and perivascular space,thrombi with perifocal edema,and area of demyelination,wth minimal reactive
ABSTRACT:
Tacrolimus is an immunosuppressive drug prescribed to many transplant patients. It has many common side effects include shaking, headache, diarrhea, constipation, nausea/vomiting (N/V), stomach upset, loss of appetite, insomnia, tingling and swelling of the extremities. In kidney transplant patients, 30% or more side effects are infection, HTN, abnormal renal function, constipation, diarrhea, N/V and insomnia. A very rare disease which is usually presented in Tacrolimus induced immunodeficiency is Progressive Multifocal Leucoencaphalopathy (PML).
We came across one such case which was initially suspected PML in 51 year old kidney …show more content…
The changes may be very subtle. It has been suggested that the less frequency grey matter pathology can be visualized better using MRI with FLAIR.FIG ()
These finding however are not specific, can be identical to those hypertensive encephalopathy. 16 such pts were identified with similar MRI findings were improved after BP control. This may also suggest synergic effect of all these cause leukoencephalopathy, which need further work up and confirmation.
CSF analysis in tacrolimus toxicity may be normal or these may be slight elevation of protein concentration. In our patient there were lymphocytic elevation and slight protein elevation, which was considered viral infection but later viral serology was reported negative.
Neuropathology in tacrolimus leukoencephalopathy shows cortical and subcortical infarcts,areas of diffuse neuronal necrosis,coagulative necrosis containing numerous macrophages,neutrophilic invasion of small cortical arteries and perivascular space,thrombi with perifocal edema,and area of demyelination,wth minimal reactive