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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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A Case of Tacrolimus Maculopathy.

Martina Santarelli1, Marco Zeppieri1, Carlo Salati1

  • 1Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy.

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Tacrolimus, an immunosuppressant, may cause maculopathy, a rare vision complication. Early detection and discontinuation can lead to recovery, but damage may be permanent.

Keywords:
maculopathyocular toxicityouter nuclear layertacrolimustransplantation

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Area of Science:

  • Ophthalmology
  • Pharmacology
  • Transplantation Medicine

Background:

  • Tacrolimus is a vital immunosuppressant for preventing rejection in solid organ transplant recipients.
  • Ophthalmic adverse effects, including optic neuropathy and cortical blindness, are known complications of Tacrolimus therapy.
  • Maculopathy is a less commonly reported, yet significant, potential ocular toxicity associated with Tacrolimus.

Observation:

  • A 56-year-old male liver transplant recipient on Tacrolimus presented with unilateral visual disturbance and a central scotoma.
  • Ophthalmologic examination confirmed unilateral maculopathy, raising suspicion of Tacrolimus-induced macular toxicity.
  • The patient experienced complete visual recovery after discontinuing Tacrolimus, though ultrastructural macular damage remained irreversible.

Findings:

  • This case report highlights maculopathy as a rare but possible complication of Tacrolimus treatment.
  • The findings suggest a potential link between Tacrolimus therapy and macular toxicity, particularly when serum levels exceed therapeutic ranges.
  • While visual function may recover, underlying macular damage can be permanent.

Implications:

  • This study underscores the importance of considering Tacrolimus maculopathy in transplant patients with visual disturbances.
  • Prompt ophthalmologic evaluation is crucial for early diagnosis and intervention to prevent irreversible vision loss.
  • Further research is warranted to elucidate the precise mechanisms and confirm the association between Tacrolimus and maculopathy.