Tacrolimus-induced plexopathy

Area of Science:

• Neuroscience
• Immunology
• Nephrology

Background:

• A 49-year-old woman with juvenile cystinosis, post-renal transplant, and on tacrolimus developed progressive, severe lumbosacral and brachial plexopathy.
• The patient also had monoclonal gammopathy of undetermined significance and diabetes, complicating the diagnostic picture.

Purpose of the Study:

• To investigate the cause of a progressive, debilitating neuropathy in an immunosuppressed transplant recipient.
• To evaluate the potential role of tacrolimus in the development of plexopathy.

Main Methods:

• Clinical case presentation with detailed neurological examination.
• Extensive diagnostic workup including bone marrow biopsy and superficial peroneal and brachial plexus nerve biopsies.
• Monitoring of neurological function and pain following a switch in immunosuppressive therapy from tacrolimus to sirolimus.

Main Results:

• Initial investigations, including nerve biopsies, were non-diagnostic for the progressive neuropathy.
• The patient experienced worsening neurological deficits and pain despite corticosteroid treatment.
• Switching immunosuppression from tacrolimus to sirolimus led to complete pain resolution and significant functional improvement.

Conclusions:

• Tacrolimus-associated plexopathy is a rare but critical consideration in transplant patients presenting with progressive neuropathy.
• Prompt recognition and management, including drug-toxicity evaluation and potential medication change, can lead to favorable outcomes.