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Posterior reversible encephalopathy syndrome: the importance of early diagnosis

Rute Teotónio1, Dina Marmoto, Cristina Januário

  • 1Department of Neurology, Hospitais da Universidade de Coimbra, Coimbra, Portugal. rute.teotonio@gmail.com

BMJ Case Reports
|September 19, 2012
PubMed

Insights

Tacrolimus, an immunosuppressant, can cause posterior reversible encephalopathy syndrome (PRES) in young heart transplant patients. Stopping the drug led to clinical and MRI recovery, highlighting the importance of prompt diagnosis.

Area of Science:

  • Neurology
  • Immunology
  • Cardiology

Background:

  • Dilated cardiomyopathy necessitates cardiac transplantation in pediatric patients.
  • Immunosuppression therapy is critical post-transplant, commonly involving corticosteroids, mycophenolate mofetil, and tacrolimus.

Observation:

  • A 14-year-old boy developed focal seizures and drowsiness on day four of immunosuppression post-cardiac transplant.
  • Neurological examination revealed right focal seizures and drowsiness, with EEG showing right occipital seizure onset.
  • MRI demonstrated diffuse subcortical white matter lesions consistent with vasogenic edema, predominantly in the right hemisphere.

Findings:

  • Tacrolimus was identified as the likely cause of posterior reversible encephalopathy syndrome (PRES).
  • Discontinuation of tacrolimus resulted in the regression of MRI abnormalities and complete clinical recovery.
  • Laboratory and CSF analyses were unremarkable, and drug levels were non-toxic, ruling out other common causes.

Implications:

  • Posterior reversible encephalopathy syndrome (PRES) is a rare but serious complication of tacrolimus in solid organ transplant recipients.
  • Early recognition and management of tacrolimus-induced PRES are crucial to prevent irreversible neurological damage.
  • This case underscores the need for vigilant neurological monitoring in patients receiving tacrolimus-based immunosuppression.

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