Tacrolimus-Induced Posterior Reversible Encephalopathy Syndrome (PRES)

Since solid organ and hematopoietic stem cell transplantations have been performed increasingly recently, use of immunosuppressive agents such as cyclosporine and tacrolimus has also risen significantly. Posterior reversible encephalopathy syndrome (PRES) is known to be a serious complication of immunosuppressive therapy use following solid organ or stem cell transplants. Clinical findings of the syndrome involve headache, mental status changes, focal neurological deficits, as well as visual disturbances, which are also associated with characteristic imaging features of subcortical white matter lesions on computed tomography (CT) or magnetic resonance imaging (MRI). Despite the fact that the alterations in subcortical white matter might be secondary to potentially reversible vasogenic edema, conversion to irreversible cytotoxic edema has also been described. These imaging findings appear to be prevalent in the territory of the posterior cerebral artery. In most earlier studies, it has been reported that the neurotoxicity associated with tacrolimus may occur at therapeutic levels. The sypmtom complex in most cases in PRES can be reversed through decreasing the dosage or withholding the drug for a few days. PRES is an uncommon complication; however, it may lead to significant morbity and mortality if ir is not diagnosed instantly. The study sheds light on the importance of MRI in prompt recognition of this syndrome, which provides us with the best chance to avoid long-run sequelae. This report highlights the value of MRI in prompt recognition of this entity, which offers the best chance of avoiding long-term sequelae. We aimed to present our 9 year-old renal transplant patient in whom we observed PRES following tacrolimus treatment in the light of clinical and MRI findings. Similar findings did not recur after tacrolimus use. Drug was not changed.