Renal transplantation
Fk 506–induced fulminant leukoencephalopathy after kidney transplantation: case report

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Case report

An 18-year-old male with chronic renal failure underwent an uncomplicated renal transplantation from his mother using an immunosuppression protocol of mycophenolate mofetil (2 × 750 mg/d), tacrolimus (2 × 3 mg/day), and prednisolone (2 × 250 mg/d).

The patient had no neurologic complaints during the early postoperative period; however, 2 months later he developed a mild tremor and cramps in both hands. His whole-blood tacrolimus level was 14.5 ng/mL (target range 5 to 20 ng/mL). The cranial

Discussion

FK 506–induced neurotoxicity may occur early or late namely, less than 2 weeks or more than 2 months after the start of treatment, respectively. The reported incidence varies from 5% to 30%.2 The precise mechanism is unknown. Although tacrolimus may produce direct neurotoxic effects, resulting in axonal swelling, increased water content and edema,10 a vascular mechanism has also been postulated. Administration of the drug has been associated with vacuolization of the smooth muscle cells of

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