Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report
Abstract Background To report a case of sudden onset left upper limb monoplegia, convulsions, and bilateral blindness in a patient receiving tacrolimus for immunosuppression following living donor liver transplantation (LDLT) consistent with posterior reversible encephalopathy syndrome (PRES). Case...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-11-01
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| Series: | Egyptian Liver Journal |
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| Online Access: | http://link.springer.com/article/10.1186/s43066-020-00064-6 |
| _version_ | 1818348647260094464 |
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| author | Mohamad-Sherif Mogawer Mostafa EL-Shazly Ayman Salah Amany Abdel-Maqsod Omar Abdelaziz Ahmed Abdel-Ghani Mahmoud Essam Abeer Awad Abdellatif |
| author_facet | Mohamad-Sherif Mogawer Mostafa EL-Shazly Ayman Salah Amany Abdel-Maqsod Omar Abdelaziz Ahmed Abdel-Ghani Mahmoud Essam Abeer Awad Abdellatif |
| author_sort | Mohamad-Sherif Mogawer |
| collection | DOAJ |
| description | Abstract Background To report a case of sudden onset left upper limb monoplegia, convulsions, and bilateral blindness in a patient receiving tacrolimus for immunosuppression following living donor liver transplantation (LDLT) consistent with posterior reversible encephalopathy syndrome (PRES). Case presentation We report a case of a 64-year-old male patient on tacrolimus treatment following LDLT. On day 11, during his post-operative routine follow-up. The patient developed sudden onset of left upper limb monoplegia associated with attacks of convulsions and sudden bilateral blindness. MRI revealed multiple, bilateral cortical, and subcortical areas of high T2 and FLAIR signal intensity that did not show restricted diffusion. Findings were suggestive of posterior reversible encephalopathy syndrome (PRES). After the cessation of tacrolimus, vision was completely regained and all other neurologic symptoms were resolved, and follow-up MRI was normal. This case represents an uncommon presentation of tacrolimus toxicity. Conclusion Tacrolimus toxicity may present with PRES. Neurological deficits may be fully reversible with discontinuation of the drug; therefore, the early recognition and prompt management of this condition are of utmost importance. |
| first_indexed | 2024-12-13T17:53:23Z |
| format | Article |
| id | doaj.art-924dea54a1fe4030b26af4a2faada42c |
| institution | Directory Open Access Journal |
| issn | 2090-6226 |
| language | English |
| last_indexed | 2024-12-13T17:53:23Z |
| publishDate | 2020-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Liver Journal |
| spelling | doaj.art-924dea54a1fe4030b26af4a2faada42c2022-12-21T23:36:26ZengSpringerOpenEgyptian Liver Journal2090-62262020-11-011011410.1186/s43066-020-00064-6Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case reportMohamad-Sherif Mogawer0Mostafa EL-Shazly1Ayman Salah2Amany Abdel-Maqsod3Omar Abdelaziz4Ahmed Abdel-Ghani5Mahmoud Essam6Abeer Awad Abdellatif7Internal medicine department, Hepatogastroenterology and liver transplantation unit, Kasr Al-Ainy Hospital, faculty of medicine, Cairo University, Cairo UniversityGeneral surgery department and liver transplantation unit, Kasr Al-Ainy Hospital, faculty of medicine, Cairo University, Cairo, Egypt., Cairo UniversityGeneral surgery department and liver transplantation unit, Kasr Al-Ainy Hospital, faculty of medicine, Cairo University, Cairo, Egypt., Cairo UniversityInternal medicine department, Hepatogastroenterology and liver transplantation unit, Kasr Al-Ainy Hospital, faculty of medicine, Cairo University, Cairo UniversityDiagnostic and intervention Radiology department, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Egypt., Cairo universityInternal medicine department, Hepatogastroenterology and liver transplantation unit, Kasr Al-Ainy Hospital, faculty of medicine, Cairo University, Cairo UniversityTropical Medicine Department, and liver transplantation unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo UniversityInternal medicine department, Hepatogastroenterology and liver transplantation unit, Kasr Al-Ainy Hospital, faculty of medicine, Cairo University, Cairo UniversityAbstract Background To report a case of sudden onset left upper limb monoplegia, convulsions, and bilateral blindness in a patient receiving tacrolimus for immunosuppression following living donor liver transplantation (LDLT) consistent with posterior reversible encephalopathy syndrome (PRES). Case presentation We report a case of a 64-year-old male patient on tacrolimus treatment following LDLT. On day 11, during his post-operative routine follow-up. The patient developed sudden onset of left upper limb monoplegia associated with attacks of convulsions and sudden bilateral blindness. MRI revealed multiple, bilateral cortical, and subcortical areas of high T2 and FLAIR signal intensity that did not show restricted diffusion. Findings were suggestive of posterior reversible encephalopathy syndrome (PRES). After the cessation of tacrolimus, vision was completely regained and all other neurologic symptoms were resolved, and follow-up MRI was normal. This case represents an uncommon presentation of tacrolimus toxicity. Conclusion Tacrolimus toxicity may present with PRES. Neurological deficits may be fully reversible with discontinuation of the drug; therefore, the early recognition and prompt management of this condition are of utmost importance.http://link.springer.com/article/10.1186/s43066-020-00064-6TacrolimusLeft upper limb monoplegiaConvulsionsSudden blindnessMRI brainPosterior reversible encephalitis syndrome |
| spellingShingle | Mohamad-Sherif Mogawer Mostafa EL-Shazly Ayman Salah Amany Abdel-Maqsod Omar Abdelaziz Ahmed Abdel-Ghani Mahmoud Essam Abeer Awad Abdellatif Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report Egyptian Liver Journal Tacrolimus Left upper limb monoplegia Convulsions Sudden blindness MRI brain Posterior reversible encephalitis syndrome |
| title | Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report |
| title_full | Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report |
| title_fullStr | Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report |
| title_full_unstemmed | Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report |
| title_short | Tacrolimus-induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia, convulsions, and sudden blindness: case report |
| title_sort | tacrolimus induced posterior reversible encephalopathy syndrome presenting as left upper limb monoplegia convulsions and sudden blindness case report |
| topic | Tacrolimus Left upper limb monoplegia Convulsions Sudden blindness MRI brain Posterior reversible encephalitis syndrome |
| url | http://link.springer.com/article/10.1186/s43066-020-00064-6 |
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