Posterior reversible leukoencephalopathy syndrome (PRES) after kidney transplantation: a case report

Davi, Carla Beatriz; Moraes, Bruna Pinheiro de; Lichtenfels, Bruno; Filho, João Batista Saldanha de Castro; Portal, Marcelle Maria; Montenegro, Rosangela Munhoz; Manfro, Roberto Ceratti

doi:10.1590/1678-4685-jbn-3825

Cited by 8 publications

(3 citation statements)

References 21 publications

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“…The occurrence of PRES in patients after transplantation secondary to tacrolimus is well-documented in the literature. This phenomenon has been observed in patients who have received liver ( 1 – 4 ), heart ( 5 , 6 ), kidney ( 7 – 9 ), and multivisceral transplants ( 10 ). In a retrospective chart review of 4,222 patients who underwent solid organ transplants, PRES developed in 21 (0.49%) patients ( 11 ).…”

Section: Discussionmentioning

confidence: 86%

Late presentation of posterior reversible encephalopathy syndrome following liver transplantation in the setting of tacrolimus and cannabis use

Zhou

Costa

McLeod

2022

CanLivJ

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A 45-year-old female presented to hospital with confusion and visual disturbances. She had undergone a liver transplant 3 years prior for cirrhosis secondary to primary biliary cholangitis. Computed tomography and magnetic resonance imaging of the brain showed features consistent with posterior reversible encephalopathy syndrome. Her medications included tacrolimus, sirolimus, and prednisone. She reported smoking 4 grams of cannabis per day. Following cessation of tacrolimus, the patient’s encephalopathy and visual disturbances resolved. To our knowledge, this case represents the longest time elapsed from liver transplantation to the development of tacrolimus-associated posterior reversible encephalopathy syndrome in the literature. This case highlights the potential danger of cannabis use in transplant recipients who are on immunosuppressants such as tacrolimus. Clinicians should have a high index of suspicion for posterior reversible encephalopathy syndrome in post-transplant patients presenting with altered mental status, even years after liver transplantation, and be familiar with potential interactions between cannabis and immunosuppressants.

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Section: Discussionmentioning

confidence: 86%

Late presentation of posterior reversible encephalopathy syndrome following liver transplantation in the setting of tacrolimus and cannabis use

Zhou

Costa

McLeod

2022

CanLivJ

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“…Five weeks after transplantation, she was admitted to the emergency due to RPES, manifested by sudden onset of confusion, disorientation, visual disturbances, and major headache. [ 17 ] Another case-control study, including 51 patients receiving tacrolimus, cyclosporine or prednisolone owing to nephrotic syndrome, of these 21 with RPES and 30 without, found that hypertension, proteinuria, hypercholesterolemia, and lower serum albumin levels were more common in RPES patients. [ 18 ] Our patient also had these risk factors, but not clear whether is caused by RPES.…”

Section: Discussionmentioning

confidence: 99%

Tacrolimus-induced epilepsy with primary membranous nephropathy

Yang

Zhang

et al. 2021

Medicine

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Rationale: Tacrolimus-associated neurologic disorders can be found in some cases, mainly in organ transplantation patients. However, epilepsy induced by tacrolimus in primary membranous nephropathy (PMN) patient is scare. Patient concerns: A 63-year-old man experienced 1-year history of foamy urine, and edema of lower extremity. Diagnosis: The patient had proteinuria, hypoalbuminemia, which indicated nephrotic syndrome. Further, we performed renal biopsy for this patient. Combined with the renal biopsy result, the diagnosis of primary membranous nephropathy was established. Intervention: At first, irbesartan was administrated for 6 months. However, the proteinuria had no obvious improvement. Tacrolimus was administrated afterwards. Outcomes: Twenty-two days after tacrolimus treatment, epilepsy occurred. Sodium valproate and carbamazepine were successively given to control epilepsy. However, the epileptic symptoms were not effectively controlled. During the treatment, the concentration of tacrolimus fluctuated greatly. At last, levetiracetam was given to maintain the curative effect. Fortunately, the patient did not suffer from epilepsy again. The concentration of temporary tacrolimus was stable, whereas proteinuria gradually decreased. Lessons: Tacrolimus-induced epilepsy should be considered in patients exhibiting acute neurological symptoms. Early diagnosis and effective treatment play a vital role for favorable prognosis.

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“…There are also immunogenic and neuropeptide hypotheses for vasogenic oedema. The former is associated with organ transplantation, where activation of T-cells and endothelial cells increases the expression of endothelial growth factors and augments endothelial permeability with consequent vasogenic oedema 24 25. The latter refers to the release of potent vasoconstrictors that cause vasospasm and ischaemia.…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome associated with the use of chemotherapeutic agents: a rare complication after treatment with vinorelbine

et al. 2020

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The posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by a combination of headache, encephalopathy, seizures and visual disturbances, associated with high-intensity abnormalities on T2-weighted images affecting subcortical white and grey matter of the occipital and parietal lobes. Among other causes, PRES has been associated with the use of several medications including chemotherapeutic agents. Here we report a case of a 65-year-old patient with squamous cell carcinoma of the lung treated with cisplatin/vinorelbine. Following the second administration of vinorelbine, she was admitted to the hospital for a generalised seizure. Blood pressure was just slightly elevated and, except for drowsiness, she had a near-normal neurological examination. MRI corroborated the diagnosis. Vinorelbine-induced PRES has been reported only once in the literature, also in association with cisplatin. Our case underlines the role of vinorelbine and suggests that its association with cisplatin in this setting may enhance the risk of PRES.

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Posterior reversible leukoencephalopathy syndrome (PRES) after kidney transplantation: a case report

Cited by 8 publications

References 21 publications

Late presentation of posterior reversible encephalopathy syndrome following liver transplantation in the setting of tacrolimus and cannabis use

Late presentation of posterior reversible encephalopathy syndrome following liver transplantation in the setting of tacrolimus and cannabis use

Tacrolimus-induced epilepsy with primary membranous nephropathy

Posterior reversible encephalopathy syndrome associated with the use of chemotherapeutic agents: a rare complication after treatment with vinorelbine

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