Ciclosporin

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Pseudotumour cerebri: case report A 26-year-old female renal transplant recipient developed pseudotumour cerebri while receiving ciclosporin for immunosuppression. The woman had developed chronic renal failure 6 years earlier and had undergone renal transplantation 2 years ago. She presented with a 4-day history of visual disturbances and headaches; at this time she was receiving ciclosporin 75mg twice daily (started 2 years earlier), azathioprine and deflazacort. Prior to onset of her symptoms, her ciclosporin concentration was within the therapeutic range. On examination, her best-corrected visual acuity (VA) was 0.8 in both eyes and no abnormalities were evident in the anterior segments. However, bilateral optic disc oedema and macular puckers were observed; the results of a pretransplant ophthalmological examination had been normal. Her BP was 150/100mm Hg. Head and orbital MRIs were unremarkable. One month later, her BP was120/80mm Hg; more antihypertensives and acetazolamide were used. Although there was improvement in her headaches, VA had worsened (0.5 OD/0.32 OS). A second eye exam detected a deterioration of right disc oedema and macular rugae while the left disc oedema had a slightly pale colour, most notably on the temporal side. Progressive bilateral papilloedema was suspected. Neurological consultation found no neurological deficits; however, her lumbar puncture opening pressure was > 30cm H2O with normal cellular and biochemical composition of the CSF. Pseudotumour cerebri secondary to ciclosporin was diagnosed. The immunosuppressant was discontinued and tacrolimus was started. Within 1 month VA of her right eye improved from 0.5 to 0.8; however, there was no improvement in VA of her left eye. Intracranial pressure gradually decreased and the bilateral papilloedema resolved within 6 months, apart from partial optic atrophy in her left eye. Lee SJ, et al. Successful switch to tacrolimus in a patient with pseudotumor cerebri following cyclosporine A treatment in renal transplantation. Dialysis and 801158345 Transplantation 38: 374-376, No. 9, Sep 2009 - South Korea

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Reactions 9 Jan 2010 No. 1283