Blindness after liver transplant

A 58-year-old woman developed a generalized seizure 12 days after undergoing liver transplantation and awakened with persistent hand motions vision binocularly. Cyclosporine levels were normal and blood pressure was only mildly elevated. The ophthalmic and neurologic examinations were otherwise normal. Brain MRI revealed bilateral parieto-occipital white matter signal abnormalities consistent with vasogenic edema. The cyclosporine was abruptly replaced with tacrolimus and the patient recovered normal vision within 48 hours. A subsequent brain MRI taken 30 days later showed that the patient had reverted to normal. This is an example of posterior leukoencephalopathy owing to cyclosporine toxicity. It points out that visual loss may be an isolated or most prominent clinical manifestation, cyclosporine and blood pressure levels may be normal, deficits are reversible if cyclosporine is promptly discontinued, and tacrolimus, a similar immunosuppressive agent, may be a safe substitute.