Posterior Reversible Encephalopathy Syndrome Improved by Changing Immunosuppressant from Calcineurin Inhibitor to Sirolimus in a Kidney Transplantation Recipient

Yunmi Kim; Si Hyeong Lee; Dong Woo Lee; Heesoo Jung; Tae-Seon Oh; Min Ji Kim; Ju Yeon Kang; Sun Woo Kang; Yeong Hoon Kim

doi:10.4285/jkstn.2015.29.3.166

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Kim, Lee, Lee, Jung, Oh, Kim, Kang, Kang, and Kim: Posterior Reversible Encephalopathy Syndrome Improved by Changing Immunosuppressant from Calcineurin Inhibitor to Sirolimus in a Kidney Transplantation Recipient

Case Report

J Korean Soc Transplant 2015;29(3):166-169.

Published online: 10 September 2015

DOI: https://doi.org/10.4285/jkstn.2015.29.3.166

Posterior Reversible Encephalopathy Syndrome Improved by Changing Immunosuppressant from Calcineurin Inhibitor to Sirolimus in a Kidney Transplantation Recipient

Yunmi Kim, M.D., Si Hyeong Lee, M.D., Dong Woo Lee, M.D., Heesoo Jung, M.D., Tae-Seon Oh, M.D., Min Ji Kim, M.D., Ju Yeon Kang, M.D., Sun Woo Kang, M.D., Yeong Hoon Kim, M.D.

¹Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Corresponding author: Yeong Hoon Kim, Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6986, Fax: 82-51-892-0273 E-mail: yeonghnl@inje.ac.kr

Received 7 August 2015 Revised 19 August 2015 Accepted 19 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Posterior reversible encephalopathy syndrome (PRES) is neurotoxicity characterized by brain imaging findings of reversible sub-cortical vasogenic edema. Clinical manifestations include seizure, altered mental status, focal neurologic deficit, and headache. Tacrolimus, a potent immunosuppressant, is related to increased risk of PRES in transplantation recipients. We report on a case of PRES in a 48-year-old female kidney transplantation recipient who received immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone. On postoperative day 14, she complained of moderate to severe headache which did not respond to usual analgesics. Magnetic resonance imaging showed high signal intensity on T2-weighted images and fluid-attenuated inverse recovery imaging in both parieto-occipital areas. The condition was improved after changing immunosuppressant from tacrolimus to sirolimus.

Keywords: Posterior leukoencephalopathy syndrome, Calcineurin inhibitors, Sirolimus, Kidney transplantation

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Fig. 1.

Brain magnetic resonance imaging showed high signal intensity at subcortical white matter of both parieto-occipital lobes in (A) T2-weighted image and (B) fluid-atte-nuated inverse recovery imaging.

Fig. 2.

Repeated brain magnetic resonance imaging taken 5 weeks later showed resolution of previously noted both parieto-occipital signal change in (A) T2-weighted image and (B) fluid-attenuated inverse recovery imaging.

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