TAKROLİMUS İLİŞKİLİ HEMORAJİK POSTERİOR REVERSİBL ENSEFALOPATİ SENDROMU: BÖBREK TRANSPLANTASYONU SONRASI GEÇ DÖNEMDE PREZENTE OLAN NADİR BİR OLGU

Öz

Organ ve doku transplantasyonu sonrası nadir görülen nörolojik komplikasyonlardan birisi olan posterior reversible ensefalopati sendromunun (PRES) gelişiminde, transplantasyon hastalarında sıkça kullanılan kalsinörin inhibitörleri gibi immünsüpresif ajanlar rol oynayabilmektedir. Sıklıkla transplantasyon sonrası erken dö- nemde görülen bu komplikasyon az sayıda olguda geç dönem- de meydana gelebilmektedir. Bu olgu sunumunda, kalsinörin inhibitörlerinin bu şiddetli ve dramatik yan etkisine dikkat çek- mek için, böbrek nakli sonrası geç dönemde gelişen, kuvvetle muhtemel takrolimus tedavisi ile ilişkili hemorajik PRES olgusunu sunmaktayız.

Anahtar Kelimeler

• PRES
• tacrolimus
• kalsinörin inhibitörleri
• transplantasyon.

TACROLIMUS ASSOCIATED HEMORRHAGIC POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: A RARE CASE IN THE LATE PERIOD AFTER RENAL TRANSPLANTATION

Öz

Immunosuppressive agents such as calcineurin inhibitors, which are commonly used in transplant patients may play a role in the development of posterior reversible encephalopathy syndrome (PRES), one of the rare neurological complications after organ and tissue transplantation. This complication, which is often seen in the early period after transplantation, occurs in the late period in a small number of cases. In this case report, to draw attention to this dramatic side effect of calcineurin inhibitors, we present a case of hemorrhagic PRES, which developed in the late period after kidney transplantation most likely associated with tacrolimus treatment.

Anahtar Kelimeler

• PRES
• tacrolimus
• calcineurin inhibitors
• transplantation

Kaynakça

1. 1. Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR Am J Neuroradiol 2002;23(6):1038-48. google scholar
2. 2. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008;65(2):205-10. [CrossRef] google scholar
3. 3. Moskowitz A, Nolan C, Lis E, Castro-Malaspina H, Perales MA. Posterior reversible encephalopathy syndrome due to sirolimus. Bone Marrow Transplant 2007;39(10):653-4. [CrossRef] google scholar
4. 4. Apuri S, Carlin K, Bass E, Nguyen PT, Greene JN. Tacrolimus associated posterior reversible encephalopathy syndrome - a case series and review. Mediterr J Hematol Infect Dis 2014;6(1):e2014014. [CrossRef] google scholar
5. 5. Wong R, Beguelin GZ, de Lima M, Giralt SA, Hosing C, Ippoliti C, et al. Tacrolimus-associated posterior reversible encephalopathy syndrome after allogeneic haematopoietic stem cell transplantation. Br J Haematol 2003;122(1):128-34. [CrossRef] google scholar
6. 6. Eidelman BH, Abu-Elmagd K, Wilson J, Fung JJ, Alessiani M, Jain A, et al. Neurologic complications of FK 506. Transplant Proc 1991;23(6):3175-8. google scholar
7. 7. Appignani BA, Bhadelia RA, Blacklow SC, Wang AK, Roland SF, Freeman RB Jr. Neuroimaging findings in patients on immunosuppressive therapy: experience with tacrolimus toxicity. AJR Am J Roentgenol 1996;166(3):683-8. [CrossRef] google scholar
8. 8. Song T, Rao Z, Tan Q, Qiu Y, Liu J, Huang Z, et al. Calcineurin inhibitors associated posterior reversible encephalopathy syndrome in solid organ transplantation: Report of 2 cases and literature review. Medicine (Baltimore) 2016;95(14):e3173. [CrossRef] google scholar

9. 9. Sila CA. Cerebrovascular Complications of Organ Transplantation. Continuum: Lifelong Learning in Neurology 2004;10(2):39-47. [CrossRef] google scholar
10. 10. Chrysant SG, Chrysant GS. Association of hypomagnesemia with cardiovascular diseases and hypertension. Int J Cardiol Hypertens 2019;1:100005. [CrossRef] google scholar
11. 11. Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V, et al. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol 2010;64(3):169-77. [CrossRef] google scholar
12. 12. Almoussa M, Goertzen A, Brauckmann S, Fauser B, Zimmermann CW. posterior reversible encephalopathy syndrome due to hypomagnesemia: A case report and literature review. Case Rep Med 2018;2018:1980638. [CrossRef] google scholar
13. 13. Kim-Tenser M, Lu Nguyen P, Barr M, Sung G. Tacrolimus induced cerebral hemorrhagic posterior reversible encephalopathy syndrome in a postcardiac transplant patient. Remed Open Access 2016;1:1033. google scholar