Teotónio Rute, Marmoto Dina, Januário Cristina, Bento Conceição
Department of Neurology, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
BMJ Case Rep. 2012 Sep 17;2012:bcr2012006852. doi: 10.1136/bcr-2012-006852.
A 14-year-old boy was submitted to cardiac transplant due to a dilated cardiomyopathy. On the fourth day of immunosuppression (corticosteroids, mycophenolate mofetil and tacrolimus), he developed right focal seizures and drowsiness. Blood pressure was in the normal range and laboratory findings in cerebral spinal fluid and blood were unremarkable, with drugs in non-toxic levels. The EEG showed a slow background rhythm more pronounced on the right and a seizure onset in the right occipital region. MRI revealed a diffuse hyperintense subcortical white-matter lesion on fluid attenuated inversion recovery, with lesser involvement of left temporal-occipital region. There was no enhancement with gadolinium and MRI diffusion-weighted imaging was consistent with vasogenic oedema. Tacrolimus was stopped with regression of MRI abnormalities and clinical recovery. Posterior reversible encephalopathy associated with tacrolimus is a rare but potentially serious complication of solid organ transplants. A prompt diagnosis and correct treatment is essential to avoid irreversible brain damage.
一名14岁男孩因扩张型心肌病接受了心脏移植手术。在免疫抑制治疗（使用皮质类固醇、霉酚酸酯和他克莫司）的第四天，他出现了右侧局灶性癫痫发作和嗜睡症状。血压在正常范围内，脑脊液和血液的实验室检查结果无异常，药物水平未达到中毒剂量。脑电图显示右侧背景节律减慢更为明显，右侧枕叶区域出现癫痫发作起始。磁共振成像（MRI）显示在液体衰减反转恢复序列上，皮质下白质弥漫性高信号病变，左侧颞枕区域受累较轻。钆增强扫描无强化，MRI弥散加权成像结果与血管源性水肿相符。停用他克莫司后，MRI异常情况消退，临床症状恢复。与他克莫司相关的后部可逆性脑病是实体器官移植中一种罕见但可能严重的并发症。及时诊断和正确治疗对于避免不可逆的脑损伤至关重要。
