Keyword: Encephalopathy
1 result found.
Case Report
Oncology, Nuclear Medicine and Transplantology, 2(1), 2026, onmt013, https://doi.org/10.63946/onmt/17728
ABSTRACT:
Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by seizures, encephalopathy, visual disturbances, and headache, often occurring in the context of hypertension and immunosuppressive therapy after solid organ transplantation. Although classically presenting with vasogenic edema in the parieto-occipital regions, atypical patterns may also occur. Here we report our experience with a case of cyclosporine-related PRES after liver transplant and summarize PRES clinical features through a literature review.
The case was a 53-year-old man who received a deceased donor liver transplant. His initial immunosuppressive therapy comprised cyclosporine/mycophenolate mofetil/prednisolone. Five months after transplantation, he was admitted to our center with altered mental status. The patient was diagnosed with PRES based on neurological symptoms and neuroimaging findings and recovered after switching from cyclosporine to everolimus. In addition, the lowering of blood pressure with drugs reported in the literature for use in PRES proved to be effective but challenging, requiring the use of multiple agents and only slowly leading to adequate control of hypertensive peaks. Nonetheless, hypertension management and supportive therapy allowed for a complete neurological recovery of the patient.
In conclusion, cyclosporine-associated PRES has a generally favorable prognosis with early diagnosis and prompt treatment, including altering or discontinuing CNIs and controlling blood pressure. CNI-associated PRES should be considered in patients exhibiting acute neurological symptoms after transplantation. Early diagnosis and immediate treatment are critical for a favorable prognosis.
The case was a 53-year-old man who received a deceased donor liver transplant. His initial immunosuppressive therapy comprised cyclosporine/mycophenolate mofetil/prednisolone. Five months after transplantation, he was admitted to our center with altered mental status. The patient was diagnosed with PRES based on neurological symptoms and neuroimaging findings and recovered after switching from cyclosporine to everolimus. In addition, the lowering of blood pressure with drugs reported in the literature for use in PRES proved to be effective but challenging, requiring the use of multiple agents and only slowly leading to adequate control of hypertensive peaks. Nonetheless, hypertension management and supportive therapy allowed for a complete neurological recovery of the patient.
In conclusion, cyclosporine-associated PRES has a generally favorable prognosis with early diagnosis and prompt treatment, including altering or discontinuing CNIs and controlling blood pressure. CNI-associated PRES should be considered in patients exhibiting acute neurological symptoms after transplantation. Early diagnosis and immediate treatment are critical for a favorable prognosis.
