Posterior Reversible Encephalopathy Syndrome Improved by Changing Immunosuppressant from Calcineurin Inhibitor to Sirolimus in a Kidney Transplantation Recipient / 대한이식학회지

ABSTRACT

Posterior reversible encephalopathy syndrome (PRES) is neurotoxicity characterized by brain imaging findings of reversible subcortical vasogenic edema. Clinical manifestations include seizure, altered mental status, focal neurologic deficit, and headache. Tacrolimus, a potent immunosuppressant, is related to increased risk of PRES in transplantation recipients. We report on a case of PRES in a 48-year-old female kidney transplantation recipient who received immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone. On postoperative day 14, she complained of moderate to severe headache which did not respond to usual analgesics. Magnetic resonance imaging showed high signal intensity on T2-weighted images and fluid-attenuated inverse recovery imaging in both parieto-occipital areas. The condition was improved after changing immunosuppressant from tacrolimus to sirolimus.