When Paranoia Comes with the Treatment: Psychosis Associated with Tacrolimus Use

Abstract

Tacrolimus is an immunosuppressive drug frequently used in solid organ transplant recipients. This drug has well-documented neuropsychiatric side effects in the literature, although emergence of psychotic symptoms is rare, being only described in a very few case reports. We present a case of a renal transplant recipient with no prior psychiatric history, who developed a severe psychosis secondary to supratherapeutic tacrolimus’ blood concentrations. This case highlights the importance of clinical awareness to rare but severe neuropsychiatric effects due to tacrolimus use.

Immunosuppressive drugs and associated complications in abdominal organ transplantation

“…after transplantation whereas having been on longterm CNI within the therapeutic range [43,44]. These findings highlight the need for considering immunosuppressive agents as a potential etiology when transplant patients present to the ICU with severe CNS abnormalities.…”

“…Cases of severe neurological complications presenting several years after transplantation have been described in patients receiving CNI based immunosuppression. These include cases of catatonia and severe psychosis presenting greater than 16 years after transplantation whereas having been on long-term CNI within the therapeutic range [43,44]. These findings highlight the need for considering immunosuppressive agents as a potential etiology when transplant patients present to the ICU with severe CNS abnormalities.…”