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Dilibe A, Subramanian L, Poyser TA, Oriaifo O, Brady R, Srikanth S, Adabale O, Bolaji OA, Ali H. Tacrolimus-induced posterior reversible encephalopathy syndrome following liver transplantation. World J Transplant 2024; 14:91146. [PMID: 38947962 PMCID: PMC11212591 DOI: 10.5500/wjt.v14.i2.91146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/13/2024] [Accepted: 04/25/2024] [Indexed: 06/13/2024] Open
Abstract
In this editorial, we talk about a compelling case focusing on posterior reversible encephalopathy syndrome (PRES) as a complication in patients undergoing liver transplantation and treated with Tacrolimus. Tacrolimus (FK 506), derived from Streptomyces tsukubaensis, is a potent immunosuppressive macrolide. It inhibits T-cell transcription by binding to FK-binding protein, and is able to amplify glucocorticoid and progesterone effects. Tacrolimus effectively prevents allograft rejection in transplant patients but has adverse effects such as Tacrolimus-related PRES. PRES presents with various neurological symptoms alongside elevated blood pressure, and is primarily characterized by vasogenic edema on neuroimaging. While computed tomography detects initial lesions, magnetic resonance imaging, especially the Fluid-Attenuated Inversion Recovery sequence, is superior for diagnosing cortical and subcortical edema. Our discussion centers on the incidence of PRES in solid organ transplant recipients, which ranges between 0.5 to 5 +ACU-, with varying presentations, from seizures to visual disturbances. The case of a 66-year-old male status post liver transplantation highlights the diagnostic and management challenges associated with Tacrolimus-related PRES. Radiographically evident in the parietal and occipital lobes, PRES underlines the need for heightened vigilance among healthcare providers. This editorial emphasizes the importance of early recognition, accurate diagnosis, and effective management of PRES to optimize outcomes in liver transplant patients. The case further explores the balance between the efficacy of immunosuppression with Tacrolimus and its potential neurological risks, underlining the necessity for careful monitoring and intervention strategies in this patient population.
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Affiliation(s)
- Arthur Dilibe
- Department of Medicine, ECU Health Medical Center, Greenville, NC 27834, United States
| | - Lakshmi Subramanian
- Department of Medicine, ECU Health Medical Center, Greenville, NC 27834, United States
| | - Tracy-Ann Poyser
- Department of Medicine, Unity Health-White County Medical Center, Searcy, AR 72143, United States
| | - Osejie Oriaifo
- Department of Medicine, ECU Health Medical Center, Greenville, NC 27834, United States
| | - Ryan Brady
- Department of Physical Medicine and Rehab, ECU Health Medical Center, Greenville, NC 27834, United States
| | - Sashwath Srikanth
- Department of Medicine, ECU Health Medical Center, Greenville, NC 27834, United States
| | - Olanrewaju Adabale
- Department of Medicine, ECU Health Medical Center, Greenville, NC 27834, United States
| | - Olayiwola Akeem Bolaji
- Department of Medicine, University of Maryland Capital Region Health, Largo, MD 20774, United States
| | - Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
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Ghali MGZ, Styler MJ. Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1702934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractThe posterior reversible encephalopathy syndrome was characterized by Hinchey and colleagues in the 1990s. The condition frequently afflicts patients suffering from hematologic and solid organ malignancy and individuals undergoing transplantation. Cases are more frequently described in the adult population compared with children. In the pediatric population, malignancy, transplantation, renal disease, and hypertension represent the most common etiologies. Theories on pathogenesis have centered upon cerebrovascular dysautoregulation with increases in blood–brain barrier permeability. This generates vasogenic edema of the cerebral parenchyma and consequent neurologic deficits. The parietal and occipital lobes are affected with greatest prevalence, though frontal and temporal lobe involvement is frequent, and that of the contents of the infratentorial posterior cranial fossa are occasionally described. The clinical presentation involves a characteristic constellation of neurologic signs and symptoms, most typically inclusive of headache, visual-field disturbances, abnormalities of visual acuity, and seizures. Supportive care, withdrawal of the offending agent, antihypertensive therapy, and prophylactic anticonvulsants affect convalescence in majority of cases. The principal challenge lies in identifying the responsible agent precipitating the condition in patients with malignancy and those having undergone transplantation and thus deciding which medication among a multidrug treatment regimen to withhold, the duration of drug cessation required to effect clinical resolution, and the safety of resuming treatment with the compound. We accordingly reviewed and evaluated the literature discussing the posterior reversible encephalopathy syndrome in children.
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Affiliation(s)
- Michael G. Z. Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Michael J. Styler
- Department of Hematology and Oncology, Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
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Sheikh-Bahaei N, Acharya J, Rajamohan A, Kim PE. Advanced Imaging Techniques in Diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES). Front Neurol 2020; 11:165. [PMID: 32218764 PMCID: PMC7078242 DOI: 10.3389/fneur.2020.00165] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/21/2020] [Indexed: 11/23/2022] Open
Abstract
Diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES) in some circumstances can be challenging and structural imaging may not be sufficient to distinguish it from other differential diagnostic considerations. Advanced imaging techniques, such as MR spectroscopy or positron emission tomography (PET) can provide additional information to determine the diagnosis. Other techniques, such as susceptibility weighted imaging (SWI) improves detection of hemorrhage which has prognostic role. CT or MR Perfusion as well as Single-Photon Emission Computed Tomography (SPECT) are more useful to understand the underlying vasculopathic changes in PRES and may answer some of the unresolved controversies in pathophysiology of this complex disease. In this review we summarized the findings of previous studies using these advanced methods and their utilities in diagnosis or prognosis of PRES.
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Affiliation(s)
- Nasim Sheikh-Bahaei
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jay Acharya
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Anandh Rajamohan
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Paul E Kim
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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FDG PET/CT Demonstrated Precursor B-cell Lymphoblastic Lymphoma in a Pediatric Patient With Hemophilia B. Clin Nucl Med 2019; 44:683-685. [PMID: 31274624 DOI: 10.1097/rlu.0000000000002582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 4-year-old boy with history of hemophilia B presented with increasingly enlarged scalp masses. Although they were initially thought as hematomas, unresponsiveness to the therapy lead to suspicion of malignancy, which prompted FDG PET/CT. The FDG PET/CT images demonstrated increased FDG uptake in the scalp masses and cervical lymph nodes. The pathology from the left scalp mass and the left cervical lymph nodes revealed precursor B-cell lymphoblastic lymphoma.
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