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Tacrolimus-Induced Akinetic Mutism or Epidural Catheter Migration: A Case Report
Patrick T Hussey1, Josiah Sowell2, Hanna Hussey1
1From the Department of Anesthesiology and Perioperative Medicine.
A&A Practice
|July 18, 2023
Summary
Tacrolimus can cause akinetic mutism, a rare side effect leading to paralysis. This case highlights the importance of considering tacrolimus-induced akinetic mutism and epidural migration in post-transplant paralysis.
Area of Science:
- Neurology
- Immunology
- Transplant Surgery
Background:
- Differential diagnosis of new-onset total body paralysis is complex.
- Tacrolimus, an immunosuppressant, can cause akinetic mutism, a rare neurological side effect.
- Epidural subarachnoid migration presents with symptoms mimicking paralysis.
Observation:
- A patient developed total body paralysis on postoperative day 1 after a double-lung transplant.
- The patient was initiated on tacrolimus and had a thoracic epidural catheter in place.
- This presentation complicated the differential diagnosis of delayed emergence/paralysis.
Findings:
- Tacrolimus-induced akinetic mutism and thoracic epidural migration were considered in the differential diagnosis.
- The case underscores the challenge in distinguishing between these conditions postoperatively.
- Prompt identification is crucial for appropriate management.
Implications:
- Highlights the need for vigilance regarding rare tacrolimus side effects in transplant patients.
- Emphasizes the importance of considering both pharmacological and mechanical causes of paralysis.
- Informs clinical practice for managing post-anesthetic and post-transplant neurological complications.
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