Encephalopathy in a Recent Lung Transplant Recipient

Area of Science:

• Medicine
• Nephrology
• Pulmonology

Background:

• A 27-year-old male lung transplant recipient, treated with tacrolimus, experienced severe primary graft dysfunction and acute renal failure.
• The patient required continuous renal replacement therapy (CRRT) and prolonged mechanical ventilation due to mucous plugging.

Observation:

• The patient exhibited a day/night inversion followed by acute confusion, combativeness, and agitation.
• Altered mentation progressed to somnolence and lethargy, necessitating endotracheal intubation for airway protection.

Findings:

• The patient developed hypotension requiring vasopressor support with epinephrine and vasopressin.
• The rapid decline in mental status suggests a potential neurological complication linked to his medical history and treatment.

Implications:

• This case underscores the importance of monitoring neurological status in lung transplant patients, especially those on immunosuppressants like tacrolimus.
• Further investigation is warranted to elucidate the specific mechanisms causing altered mental status in this complex clinical scenario.