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

(6 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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“…Each reported case of postoperative PRES was analyzed from the perspective of the pathology of interest, going on to hypothesize, for example, the role of primary damage to the BBB in cases of operated posterior cranial fossa lesions [15,18,46], or immunosuppressive therapy [17,20,21,39,40] in patients undergoing organ transplantation [35,52]. Instead, we believe that in individuals predisposed to have primary endothelial damage, a stressful incident such as surgery of whatever type may result in postoperative PRES in rare cases.…”

Section: Discussionmentioning

confidence: 99%

Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?

et al. 2023

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Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by neurological symptoms and distinctive neuroimaging findings. There are a few cases reported in the literature in which PRES can occur after surgery, and there is no clear direct relationship between a procedure and its debut. Methods: We performed a review of the literature by analyzing all reported cases of PRES syndrome which debuted after a surgical procedure with the aim of identifying the clinical features, the timing of the symptoms’ onset and the therapy of patients suffering from this unusual surgical complication. Results: The total number of patients collected was 47, with a mean age of 40.9 years. Postoperative PRES can occur in either pediatric or adult patients (ages 4–82 years). The most frequent form of comorbidity reported was cardiovascular disease (fourteen patients, 29.78%). Sixteen patients (36%) had no relevant risk factors or comorbidities at the time of the surgical procedure. The types of surgery most correlated were cranial neuro and maxillofacial surgery (twenty-one patients, 44.68%) followed by transplant surgery (eight patients, 17%). The time of onset of PRES after surgery occurred within the first 3 weeks (mean time of onset 4.7 days), and when rapidly treated with antihypertensive and antiepileptic drugs appeared to have a reversible and benign course. Conclusion: PRES syndrome can be considered a rare complication of procedures and can occur following a wide range of surgeries, especially cranial and transplant surgery. Being able to recognize it in time and treat it ensures a full reversibility of symptoms in most cases.

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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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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

Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?

Tacrolimus-induced epilepsy with primary membranous nephropathy

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