School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Transpl Immunol. 2023 Oct;80:101907. doi: 10.1016/j.trim.2023.101907. Epub 2023 Jul 26.
Posterior Reversible Encephalopathy Syndrome (PRES) is a rare neurological disorder with a wide range of neurological symptoms. Different risk factors are known for PRES in patients with a history of kidney transplantation; these patients developing PRES were associated with immunosuppressants and cytotoxic drug therapies, including reports of rituximab therapy. Herein, we report a case of rituximab-associated PRES in the context of antibody-mediated kidney allograft rejection. A 29-year-old male patient with antibody-mediated kidney rejection was treated with rituximab, and then he developed PRES. The patient, who was transplanted with a kidney allograft five years earlier, was continuously treated with standard tacrolimus and mycophenolate mofetil therapy without any symptoms of PRES. Rituximab treatment was started to block an ongoing kidney rejection, and the patient received a second dose of rituximab four days prior to the hospital admission. At admission, the patient demonstrated symptoms of headache, nausea, and photophobia. The brain magnetic resonance imaging (MRI) showed changes consistent with PRES. After 12 days of hospitalization, he was discharged with a complete cessation of the initial symptoms. We postulate that possible endothelial dysfunction caused by rituximab may explain the condition leading to PRES. It is unclear whether rituximab, when used in kidney rejection patients who receive other immunosuppressants, may contribute to PRES.
后部可逆性脑病综合征（PRES）是一种罕见的神经系统疾病，具有广泛的神经系统症状。已知有肾移植病史的患者发生 PRES 的风险因素很多；这些发生 PRES 的患者与免疫抑制剂和细胞毒性药物治疗有关，包括利妥昔单抗治疗的报告。在此，我们报告了一例抗体介导的肾移植排斥反应背景下与利妥昔单抗相关的 PRES 病例。一名 29 岁男性患者因抗体介导的肾排斥反应接受了利妥昔单抗治疗，随后出现 PRES。该患者五年前接受了肾移植，一直接受标准的他克莫司和霉酚酸酯治疗，没有 PRES 的任何症状。开始使用利妥昔单抗来阻止正在进行的肾排斥反应，并且在入院前四天患者接受了第二剂利妥昔单抗。入院时，患者表现出头痛、恶心和畏光的症状。脑部磁共振成像（MRI）显示符合 PRES 的变化。住院 12 天后，他完全停止了最初的症状出院了。我们推测，利妥昔单抗可能引起的内皮功能障碍可以解释导致 PRES 的情况。目前尚不清楚在接受其他免疫抑制剂的肾排斥反应患者中使用利妥昔单抗是否会导致 PRES。
