Dopke Kelly M, El Seblani Nader, Mercer Katherine, Naik Sunil, Mainali Gayatra, Paul Dustin
Penn State Health, Pediatric Neurology, Pediatric Neuromuscular Medicine, 30 Hope Drive, Suite 1300, Hershey, PA 17033, USA.
Child Neurol Open. 2023 Apr 18;10:2329048X231171011. doi: 10.1177/2329048X231171011. eCollection 2023 Jan-Dec.
A 17-year-old female with sickle cell disease status post a recent stem cell transplant and on tacrolimus developed an acute expressive aphasia, dysphagia, and drooling. Brain MRI revealed diffuse restricted diffusion involving the bilateral corona radiata and areas of white matter in the right cerebral hemisphere most consistent with toxic leukoencephalopathy. Tacrolimus serum concentration was high at 19.3 ng/ml (ref 9-12 ng/ml) for which tacrolimus was discontinued. She was neurologically back at baseline 2 days later with the tacrolimus level improving to 8.2 ng/mL. Following discontinuation and the declining trend of her tacrolimus levels the patient returned to her neurologic baseline and was subsequently switched to mycophenolate mofetil for GVHD immunosuppression.
一名17岁患有镰状细胞病的女性，近期接受了干细胞移植并服用他克莫司，出现了急性表达性失语、吞咽困难和流口水症状。脑部MRI显示双侧放射冠和右侧大脑半球白质区域存在弥漫性扩散受限，最符合中毒性白质脑病。他克莫司血清浓度高达19.3 ng/ml（参考值9 - 12 ng/ml），因此停用了他克莫司。两天后她的神经功能恢复到基线水平，他克莫司水平降至8.2 ng/mL。在停用他克莫司且其水平呈下降趋势后，患者恢复到神经功能基线状态，随后改用霉酚酸酯进行移植物抗宿主病免疫抑制治疗。
