Tacrolimus
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Left optic neuritis: case report A 52-year-old woman developed left optic neuritis during immunosuppressive treatment with tacrolimus. The woman presented on 5 April 2018 with left paracentral black dots progressing over a week, associated with periorbital and temporal pain. On an anamnesis, it was found that she had undergone a kidney transplantation due to hypertensive renal failure in 2002. She had been receiving immunosuppressive drug treatment with tacrolimus [FK506; route not stated] 3 mg/day for 16 years, mycophenolate mofetil [Cellcept] and prednisolone. During regular follow-up visits with an ophthalmologist, she had a normal fundal examination and had no other complaints. On current presentation, an ophthalmologist confirmed left papillitis. Additionally, she had left relative afferent pupillary defect (RAPD), early lens cataract, with visual acuity in the right eye 20/20 and in the left eye 20/60. She was referred to the neurology department on 09 May 2018 for a comprehensive evaluation. On evaluation, physical examination showed the same visual acuity with normal extraocular muscles, pain in the left eye with movement and continued left papillitis. Additionally, cranial nerves, motor and cerebellar examinations were unremarkable except for antalgic gait. She denied any fever, jaw claudication, ptosis, diplopia, recent vaccinations, travel history, weight loss or any other visual disturbances. Serum tacrolimus level was within the normal range and did not exceed for 5 years. An MRI of the brain and orbits obtained performed 4 week of the presentation excluded the neoplastic etiologies but showed multiple white matter foci, consistent with mild chronic ischaemic changes. Serology for neuromyelitis optica antibodies, oligo-clonal band antibodies and CSF analysis was found to be negative. Laboratory investigations revealed an increased level of CRP and ESR. Infectious etiologies were excluded, and stains for cytomegalovirus and mycobacterium were found to be negative. She was diagnosed with tacrolimus-associated left optic neuritis. The woman was discharged on a tapered dose of tacrolimus of 1.5mg daily. At 3-week follow-up (i.e. on 29 May 2018), tacrolimus was replaced by ciclosporin. At the 6-month followup (i.e. 11 December 2018), she showed no improvement and her symptoms remained similar to the previous state. Author comment: "Tacrolimus, a calcineurin inhibitor, has shown neurotoxic properties causing optic neuropathy in cases of bone, liver, and islet pancreatic transplantations, even at non-toxic levels." Alnahdi MA, et al. Delayed tacrolimus-induced optic neuropathy. Neurosciences 24: 324-326, No. 4, Oct 2019. Available from: URL: http://doi.org/10.17712/ 803437886 nsj.2019.4.20190022 - Saudi Arabia
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Reactions 7 Dec 2019 No. 1782
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