Delayed tacrolimus-induced optic neuropathy.

Area of Science:

• Nephrology
• Ophthalmology
• Neurology

Background:

• Tacrolimus is a vital immunosuppressant for solid organ transplant recipients.
• Neurotoxic effects are rare but documented adverse events associated with tacrolimus therapy.
• Long-term immunosuppression management requires monitoring for potential complications.

Observation:

• A 52-year-old female kidney transplant recipient presented with a week of progressive unilateral left paracentral black dots.
• Symptoms were associated with periorbital and temporal pain, leading to a diagnosis of left papillitis.
• The patient had been on tacrolimus (3mg daily) for 16 years as part of her immunosuppressive regimen.

Findings:

• Despite tapering tacrolimus and switching to cyclosporine, the patient's papillitis and associated symptoms showed no improvement.
• This case suggests a potential delayed neurotoxic effect of tacrolimus manifesting as unilateral optic neuropathy.
• The optic neuropathic effect occurred more than a decade after initiating tacrolimus therapy.

Implications:

• This case underscores the importance of considering tacrolimus-induced neurotoxicity, specifically optic neuropathy, in transplant patients presenting with visual disturbances.
• Delayed onset of neurotoxic effects, even years after transplantation, should be recognized in clinical practice.
• Further investigation into the mechanisms and long-term sequelae of tacrolimus-related optic neuropathy is warranted.