[Neurological symptoms in patient with focal segmental glomerulosclerosis treated with cyclosporin A--case report]

Cyclosporin A using in treatment glomerulonephritis can cause neurological side effects.

Nephrotic syndrome (NS) with microscopic hematuria was recognized in a boy in the age of 9.7 years. In kidney biopsy focal and segmental glomerulosclerosis was found. Remission was obtained on oral prednisone (60 mg/24 hrs). Second relapse of NS was treated with methylprednisolone pulse (VI pulses--600 mg/pulse) with a good effect. Third relapse of NS (secondary steroidoresistency) was treated with oral cyclophosphamide in a total dose 140 mg/kg/therapy--the treatment was complicated by a massive oral cavity mycosis and sinusitis. 3 weeks after starting cyclosporine A (CsA) proteinuria subsided. During CsA treatment severe headaches and pains in orbits with nausea appeared. In neurological examinations no abnormalities were found, in ophthalmological examination--slight opacification of the lens was found. EEG revealed lesions localised in a posterior cerebral parts, and CT of the head showed slight dilatation of ventricles. In MRI foci of signal intensification were found in subcortical white substance. CsA was stopped after 4 months of the treatment and prednisone was stopped a month later. Control MRI after 6 months revealed maintenance of the foci in white substance. The patient is under nephrological care, has no proteinuria and no neurological symptoms.

In patients treated with CsA appearance of headaches may suggest medication neurotoxicity.