Chand Siddharth, Sharma Riya, Kaur Alaipreet, Mishra Saurabh, Varghese Victo, Kumar Manoj, Mahdi Raza A, Goyal Manoj K, Shree Ritu
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India.
Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India.
Neurol Sci. 2025 May 23. doi: 10.1007/s10072-025-08248-x.
Tacrolimus is an immunosuppressant agent widely used in organ transplantation. Neurotoxicity due to tacrolimus is frequently reported in the literature with varied presentations from tremors to leukoencephalopathy. Drugs used to prevent graft rejection can cause significant morbidity.
A 65-year-old male developed rapidly progressive dementia shortly after liver transplantation. Imaging revealed abnormal signal intensities, symmetrically involving bilateral caudate head and putamen with diffusion restriction mimicking CJD. Blood levels of tacrolimus were repeatedly normal. He improved completely over 4-6 weeks after stopping tacrolimus.
Tacrolimus is used on a daily basis in most post-transplantation patients. Neurotoxicity related to the medications must be kept in the differential list while investigating rapidly progressing dementia. This case highlights the importance of suspecting tacrolimus toxicity even with therapeutic drug levels.
他克莫司是一种广泛用于器官移植的免疫抑制剂。文献中频繁报道他克莫司所致的神经毒性，其表现多样，从震颤到白质脑病不等。用于预防移植物排斥的药物可导致严重的发病率。
一名65岁男性在肝移植后不久出现快速进展性痴呆。影像学检查显示异常信号强度，双侧尾状核头部和壳核对称受累，弥散受限，类似克雅氏病。他克莫司的血药浓度多次正常。停用他克莫司后4 - 6周，他完全康复。
大多数移植后患者每天都使用他克莫司。在调查快速进展性痴呆时，必须将与药物相关的神经毒性列入鉴别诊断清单。本病例强调了即使在治疗药物浓度正常时也怀疑他克莫司毒性的重要性。
