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Posterior reversible encephalopathy syndrome: case report A 63-year-old woman developed posterior reversible encephalopathy syndrome (PRES) during treatment with linezolid and tacrolimus [routes, dosages and duration of treatment to reaction onset not stated]. The woman presented to a hospital following multiple episodes of seizure. She underwent a deceased donor renal transplantation 6 months previously. It was complicated by a persistent right perinephric fluid collection. She was being treated with piperacillin/tazobactam therapy. Subsequently, she started receiving linezolid 7 days prior to the current admission. She had been receiving tacrolimus, mycophenolate and prednisone. On the day of admission, she experienced nausea, diarrhoea and vomiting. The woman received midazolam and was intubated. Eventually, seizures were controlled. She was afebrile with a heart rate of 85, BP of 189/100 and oxygen saturation 100% while intubated. The neurologic evaluation showed sedation. Laboratory examination showed normocytic, normochromic anaemia and thrombocytopenia. Her creatinine was 2.32 mg/dL and blood urea nitrogen was 42. A head CT scan showed masses or areas of infarction. A CT abdomen confirmed stranding around the right transplanted kidney. A brain MRI demonstrated symmetric sub-cortical areas of abnormal hyper-intense T2/FLAIR involving mainly occipital lobes, and frontal lobes with a minimal focal area of susceptibility. On the basis of these findings, a diagnosis of PRES was made. Subsequently, tacrolimus was stopped and the linezolid therapy was adjusted. The patient remained afebrile, seizure-free and normotensive. She was extubated on day 3 hospitalisation. Author comment: "The clinician should consider linezolid as a contributing factor in the development of tacrolimus associated PRES." Marmol M, et al. Linezolid as contributing factor in tacrolimus associated posterior reversible encephalopathy syndrome. Journal of Hospital Medicine 13 (Suppl. 1): abstr. 709, No. 4, Jan 2018. Available from: URL: https://www.shmabstracts.com/ abstract/linezolid-as-contributing-factor-in-tacrolimus-associated-posterior803432341 reversible-encephalopathy-syndrome/ [abstract] - USA

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Reactions 9 Nov 2019 No. 1778