Tamaki Hiroya, Kawakami Manabu, Ikegame Kazuhiro, Iio Kenichiro, Harada Yu, Hatanaka Kazuo, Oka Yoshihiro, Kawase Ichiro, Ogawa Hiroyasu
Department of Molecular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Int J Hematol. 2004 Oct;80(3):291-4. doi: 10.1532/ijh97.04084.
A 46-year-old woman with Hodgkin's disease who underwent nonmyeloablative allogeneic stem cell transplantation developed cortical blindness, seizures, and left hemiparesis on day 100 while receiving tacrolimus (FK506) and prednisone for the treatment of graft-versus-host disease (GVHD). Magnetic resonance imaging revealed multiple changes, mainly in the bilateral occipital lobes, suggesting FK506-related leukoencephalopathy. These abnormalities improved after discontinuation of FK506. However, 3 days after the episode, cerebral hemorrhage in the left occipital lobe with perforation to the left subdural space occurred. Although FK506-induced leukoencephalopathy with cerebral hemorrhage is considered the more severe form of such leukoencephalopathy, the patient's neurological symptoms almost completely resolved and radiographic findings improved after discontinuation of FK506, tapering of methylprednisolone, and initiation of mycophenolate mofetil. FK506-related leukoencephalopathy is a rare complication after allogeneic stem cell transplantation. Although the symptoms usually subside after discontinuation of FK506, therapeutic intervention in many cases may result in severe complications, including GVHD and vascular disease. We consider it important to use immunosuppressive agents without vascular endothelial toxicity for preventing the development of fatal GVHD after discontinuation of FK506.
一名46岁患有霍奇金淋巴瘤的女性患者接受了非清髓性异基因干细胞移植，在移植后第100天，在接受他克莫司（FK506）和泼尼松治疗移植物抗宿主病（GVHD）时出现皮质盲、癫痫发作和左侧偏瘫。磁共振成像显示多处改变，主要在双侧枕叶，提示与FK506相关的白质脑病。停用FK506后这些异常情况有所改善。然而，在该事件发生3天后，左侧枕叶发生脑出血并破入左侧硬膜下间隙。尽管FK506诱发的白质脑病合并脑出血被认为是此类白质脑病的更严重形式，但在停用FK506、逐渐减少甲泼尼龙用量并开始使用霉酚酸酯后，患者的神经症状几乎完全缓解，影像学表现也有所改善。FK506相关的白质脑病是异基因干细胞移植后一种罕见的并发症。虽然症状通常在停用FK506后消退，但在许多情况下，治疗干预可能会导致严重并发症，包括GVHD和血管疾病。我们认为，为防止停用FK506后发生致命的GVHD，使用无血管内皮毒性的免疫抑制剂很重要。
