Posterior Reversible Encephalopathy Syndrome after Heart Transplantation: Diagnosis and Immunosuppressive Therapy

Tex Heart Inst J. 2017 Jun 1;44(3):205-208. doi: 10.14503/THIJ-15-5007. eCollection 2017 Jun.

Abstract

Posterior reversible encephalopathy syndrome, an infrequent neurotoxicity associated with the use of tacrolimus, was first described in 1996, as a reversible syndrome manifested by headache, altered mental function, seizures, and visual disturbances. We describe the case of a 37-year-old woman who developed neurologic symptoms consistent with encephalopathy after treatment with tacrolimus, which was prescribed to maintain immunosuppression after orthotopic heart transplantation. This report also discusses the imaging methods used in the diagnosis of posterior reversible encephalopathy and highlights the difficulty of maintaining immunosuppression and managing medication-related adverse effects, while taking into account the risk of acute rejection after transplantation.

Keywords: Brain diseases/diagnostic imaging; drug therapy, combination; graft rejection/heart transplantation/adverse effects; immunosuppressive agents/therapeutic use; nervous system diseases/chemically induced; tacrolimus/adverse effects/therapeutic use; treatment outcome.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Diffusion Magnetic Resonance Imaging
  • Drug Substitution
  • Female
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control
  • Graft Survival / drug effects
  • Heart Transplantation* / adverse effects
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects*
  • Posterior Leukoencephalopathy Syndrome / chemically induced*
  • Posterior Leukoencephalopathy Syndrome / diagnostic imaging
  • Sirolimus / administration & dosage
  • Tacrolimus / administration & dosage
  • Tacrolimus / adverse effects*
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Sirolimus
  • Tacrolimus