Short communication, Note
Neurotoxicity that May Mimic Progressive Multifocal Leukoencephalopathy in Patient with Transplanted Kidney
Meri Matijaca
Jadranka Vlašić-Matas
Stipan Janković
Irena Pintarić
Anton Marović
Abstract
We present the 55-year old woman who has had kidney transplantation three times. She has been treated with immunosuppressive
therapy and lamivudine for hepatitis B and C. Nine years after the last transplantation she showed neurological
symptoms that presented in the form of confusion and epileptic seizures of the grand mal type. A brain MRI
showed large oval zones of hyperintense MR signal in T2- weighted image and hypointense in T1- weighted image
around the frontal horns of the lateral ventricles, bilaterally and in both cerebellar hemispheres. After reduction in
immunosuppression and the exclusion of lamivudine from therapy, the patient was stable with normal neurological status
during the course of next five years. We start from the assumption that the concomitant use of cyclosporin with
mycophenolate mofetil and lamivudine, despite normal concentrations of cyclosporin, might cause the accumulation of
toxic metabolites and lead to neurotoxicity that mimics PML in a chronic viral environment.
Keywords
immunocompromised patient; immunosuppressive therapy; kidney transplantation; neurotoxicity; progressive multifocal leukoencephalopathy (PML)
Hrčak ID:
27316
URI
Publication date:
4.1.2007.
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