Mycophenolate mofetil/tacrolimus
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Progressive multifocal leukoencephalopathy: case report A 41-year-old woman developed progressive multifocal leukoencephalopathy (PML) during immunosuppressive therapy with mycophenolate mofetil and tacrolimus. The woman had autoimmune hepatitis for which she had undergone orthotopic liver transplantation in 2016. Following the transplantation, she started receiving immunosuppressive therapy with mycophenolate mofetil [CellCept] and tacrolimus [routes and dosages not stated]. Two months following the liver transplantation, she exhibited a stroke attack, which resulted in right hemiplegia. In August 2016, she developed left central facial paresis and dysarthria, and she could not express the words correctly. The woman was hospitalised. A mild right paresis was noted. Neurological examinations revealed normal muscle force of the left and right limbs. Her speech was unclear. A brain MRI demonstrated an abnormal multifocal area with a high T2/flair signal in the deep sub-cortical white matter of the left hemisphere and the splenium of her corpus callosum. Initially, she was thought to have developed stroke, but the MRI findings were indicative of PML. Following a few days, her neurological deficit progressed, which resulted in complete aphasia and paresis. Based on her disease condition, immunodeficient condition and multifocal lesions in the white matter, a differential diagnosis included PML, cytomegaloviral encephalitis, post-transplant lymphoproliferative disorder, cryptococcal meningoencephalitis, neuro-vasculitis and mycobacterial meningitis. Further, polymerase chain reaction of CSF was positive for JC-virus DNA. Therefore, she was diagnosed with PML. Consequently, mycophenolate mofetil was tapered, and tacrolimus was discontinued. She then started receiving sirolimus. During the subsequent weeks, her neurological deficits including facial hemiparesis and aphasia improved. After 1 month, she was discharged with adjustment of the dose of the immunosuppressive drug insisting on following up neurological symptoms improvement. Subsequently, her muscle forces and speech improved significantly Author comment: "PML is a demyelination neurologic disorder caused by JCV. This disease is usually found in immunocompromised patients including organ transplant recipients,cancer patients, and patients receiving lymphocytetargeted drug treatment for autoimmune disorders and HIV infection." Ahmadinejad Z, et al. A 41-year-old female with progressive multifocal leukoencephalopathy after liver transplant. Journal of NeuroVirology 25: 605-607, No. 4, Aug 2019. Available from: URL: http://doi.org/10.1007/ 803435800 s13365-019-00742-1 - Iran
0114-9954/19/1780-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 23 Nov 2019 No. 1780
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