tacrolimus and Guillain-Barre-Syndrome

Topics: Guillain-Barre Syndrome; Humans; Tacrolimus

Guillain-Barrè Syndrome, as part of the spectrum of dysimmune neuropathies, is unexpected to occur in immunocompromised hosts. We describe a clinical case of Guillain-Barrè syndrome, occurred a few weeks after a liver transplant, and we postulate that our case would satisfy all requirements to explain this peripheral nervous system complication as a clinical manifestation of an Immune reconstitution inflammatory syndrome. In this setting of liver transplantation, complicated by potentially multiple infective triggers, reduction of immunosuppression and reversal of pathogen-induced immunosuppression, through antimicrobial therapy, may have led to pro-inflammatory response. The pro-inflammatory pattern would have sustained the pathophysiologic mechanism of this immune neuropathy.

Topics: Female; Guillain-Barre Syndrome; Humans; Immune Reconstitution Inflammatory Syndrome; Immunosuppression Therapy; Inflammation; Liver Transplantation; Tacrolimus

Guillain-Barré syndrome (GBS) is an acute polyneuropathy caused by an autoimmune response towards a foreign antigen, notably viral infections. It is characterised by a symmetrical ascending paralysis with treatment remaining largely supportive; however, plasma exchange or intravenous immunoglobulins can be used to shorten recovery time.. We describe a case of severe acute GBS in a patient post-renal transplantation. The 44-year-old gentleman's induction therapy consisted of methyl prednisolone and basiliximab, with subsequent tacrolimus and mycophenolate mofetil as immunosuppressive agents. Tacrolimus was discontinued immediately on suspicion of a temporal relationship with the patient's condition, and substituted with a combination of ciclosporin, mycophenolate mofetil and prednisolone. Due to extensive patient screening prior to transplant, negative virology/immunology and normal nerve biopsy findings, both tacrolimus and basiliximab may be indicated as causative agents.. Immunosuppressive-induced GBS should be considered a differential diagnosis in patients on tacrolimus or basiliximab with acute-onset limb weakness, especially if recently commenced. Discontinuation of tacrolimus and initiation of plasma exchange for the treatment for tacrolimus-associated GBS may be beneficial.

Topics: Adult; Diagnosis, Differential; Graft Rejection; Guillain-Barre Syndrome; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Tacrolimus; Treatment Outcome

Guillain-Barré syndrome (GBS) has been rarely reported after liver transplantation and generally has good outcome. We report a liver transplant patient on FK506 (tacrolimus) who developed GBS 6 months after liver transplantation. There was no evidence of liver rejection or active infection. Despite treatment with intravenous immunoglobulin, the patient expired. GBS occurred despite downregulation of T cells by FK506, suggesting that humoral dysfunction might be the predominant mechanism of GBS in this report.

Topics: Fatal Outcome; Guillain-Barre Syndrome; Humans; Immunosuppressive Agents; Influenza Vaccines; Liver Transplantation; Male; Middle Aged; Tacrolimus; Vaccination