Central pontine myelinolysis (CPM) associated with tacrolimus (FK506) after liver transplantation

Tacrolimus-induced Permanent Asymptomatic Pontine Myelinolysis after Liver Transplantation

“…Two weeks later, the lesion had reduced in size (Picture 2A). A diagnosis of tacrolimus neurotoxicity was considered, as tacrolimus is highly lipophilic and its accumulation in lipidrich myelin can cause demyelination (2). One year later, the lesion persisted (Picture 2B).…”

Nephro and neurotoxicity of calcineurin inhibitors and mechanisms of rejections: A review on tacrolimus and cyclosporin in organ transplantation

“…The broad range of nervous system disorders most frequently encountered includes tremors, headache and insomnia, with other less common manifestations including paraesthesia and seizures (1,(47)(48)(49)(50)(51)(52)(53).…”

Pearls & Oy-sters: Tacrolimus neurotoxicity presenting as an isolated brainstem lesion

“…Brain PET scan revealed no abnormalities of FDG-PET uptake. Based on few reports in the literature of tacrolimus-induced neurotoxicity, [1][2][3][4][5] we hypothesized that this was the potential culprit and changed to cyclosporine. Tacrolimus levels were therapeutic throughout his hospitalization (6.3-9.0 ng/mL).…”

“…[1][2][3][4][5] Tacrolimus is an immunosuppressive agent that inhibits calcineurin phosphatase activity and T lymphocyte activation. 7 Neurologic adverse effects range from tremors and headaches to cortical blindness and status epilepticus.…”

“…In a prospective study of 14 patients with tacrolimus neurotoxicity, 5 had white matter abnormalities on brain MRI, one had putaminal hemorrhage, and 8 were normal. 10 We found only 5 prior reports describing tacrolimus neurotoxicity presenting as a pontine predominant lesion with hyperintense signal on T2-weighted MRI, [1][2][3][4][5] and in these cases, the clinical presentations varied widely.…”