tacrolimus and Polyneuropathies

Tacrolimus is an immunosuppressant frequently used following solid organ transplantation, including renal transplantation. Peripheral neuropathy is an uncommon neurological side effect of tacrolimus and has rarely been reported in renal transplantation. We report a patient who received a living-related donor kidney transplant and presented with altered mental status and new-onset bilateral foot drop. Laboratory tests including cerebrospinal fluid tests excluded infection, and MRI of the brain showed chronic microvascular ischaemic changes. Electromyography and nerve conduction study confirmed bilateral common peroneal nerve demyelination. He was also found to have inadvertently overdosed on tacrolimus at home. After switching from tacrolimus to cyclosporine, the patient's symptoms improved within 5 months. His renal function was maintained with an immunosuppressant regimen of cyclosporine, prednisone and mycophenolic acid. The prompt recognition of tacrolimus as a potential neurotoxic drug in a patient with renal transplant and substituting tacrolimus with a different immunosuppressant may prevent permanent neurological damage.

Topics: Aged; Brain Diseases; Diagnosis, Differential; Electromyography; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Neural Conduction; Polyneuropathies; Risk Factors; Tacrolimus

Graft-versus-host disease (GVHD) is an immune-mediated multisystemic disorder and the leading cause of morbidity after allogeneic hematopoietic stem cell transplantation. Peripheral nervous system manifestations of GVHD are rare but often disabling. Whereas immune-mediated neuropathies are an established feature of GVHD, muscle cramps are not well characterized.. In a single-centre retrospective cohort we studied 27 patients (age 23 to 69 years) with GVHD (acute n = 6, chronic n = 21) who complained of symptoms suggestive of peripheral nervous system complications. Clinical, laboratory and neurophysiological findings were evaluated by descriptive statistics and regression analysis to detect factors associated with muscle cramps. Patient's sera were examined for anti-neuronal antibodies.. Nine patients had polyneuropathy, 4 had muscle cramps, and 14 had both. Median onset of polyneuropathy and muscle cramps was 6 and 9 months after allogeneic hematopoietic stem cell transplantation, respectively. Neurophysiology revealed a predominantly axonal polyneuropathy in 20 of 26 patients. In 4 of 19 patients electromyography showed signs of myopathy or myositis. Muscle cramps were more frequent during chronic than acute GVHD and affected muscles other than calves in 15 of 18 patients. They typically occurred daily, lasted 1 to 10 minutes with medium to severe pain intensity, compromised daily activity or sleep in 12, and were refractory to therapy in 4 patients. Muscle cramps were less likely with tacrolimus treatment and signs of severe polyneuropathy, but more likely with myopathic changes in electromyography and with incipient demyelinating polyneuropathy, shown by increased high frequency attenuation of the tibial nerve. Serological studies revealed antinuclear or antimitochondrial antibodies in a subset of patients. Two of 16 patients had a serum reactivity against peripheral nervous tissue.. Muscle cramps are associated with chronic GVHD, often compromise daily activity, and correlate negatively with axonal polyneuropathy and positively with myopathy and incipient demyelination.

Topics: Adult; Aged; Female; Follow-Up Studies; Graft vs Host Disease; Hematologic Tests; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Muscle Cramp; Polyneuropathies; Retrospective Studies; Serologic Tests; Tacrolimus; Time Factors; Transplantation, Homologous; Young Adult

Tacrolimus has been often described to induce neuropathy in liver-, pancreas-, and renal-transplanted patients. Here, we report the first case of a 56-year-old woman who developed a progressive symmetric demyelinating sensorimotor polyneuropathy in the distal muscles of the lower limbs after therapy with tacrolimus because of heart transplantation. This condition suddenly reverted after the tacrolimus was stopped.

Topics: Demyelinating Diseases; Diagnosis, Differential; Disease Progression; Drug Monitoring; Female; Heart Transplantation; Humans; Immunosuppressive Agents; Lower Extremity; Middle Aged; Polyneuropathies; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Tacrolimus; Treatment Outcome

Patients, in particular recipients of orthotopic liver transplants, receiving the immunosuppressant tacrolimus (FK-506), are at risk for developing central neurotoxic adverse events. We report the occurrence of a tacrolimus-induced peripheral neurotoxic event, i.e. pure motor axonal polyneuropathy of the lower limbs in a 44-year-old woman, 9 days after combined orthotopic liver and pancreas transplantation. She was treated for 5 days with intravenous immunoglobulins. Partial recovery followed over months to years. An overview of all 11 reported FK506-associated polyneuropathies is given.

Topics: Adult; Female; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Liver Transplantation; Magnetic Resonance Imaging; Multiple Endocrine Neoplasia Type 1; Pancreas Transplantation; Pancreatectomy; Polyneuropathies; Tacrolimus

Tacrolimus is used widely for immunosuppression following transplantation. It has rarely been linked to the development of peripheral neuropathy. However, one study also reported improvement in peripheral neuropathy after tacrolimus use. We have reported herein two patients who developed chronic sensorimotor polyneuropathy after tacrolimus use following renal transplantation. One patient had an unusual presentation with bilateral facial and extremity weakness and a relapsing course. The other patient presented with focal sensory symptoms in one hand. Electrophysiological studies confirmed widespread, predominantly demyelinating or axonal polyneuropathy. We concluded that patients on tacrolimus should be carefully monitored for symptoms suggestive of peripheral neuropathy.

Topics: Adult; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Neural Conduction; Peripheral Nervous System Diseases; Polyneuropathies; Postoperative Complications; Tacrolimus

FK 506 is a potent immunosuppressive agent in clinical use in solid organ transplantation since 1989. Approximately 5% of patients receiving FK 506 develop major central nervous system toxicity but peripheral nervous system involvement is very uncommon, and there are only 4 reported cases of demyelinating polyneuropathy in patients who received a liver transplant. We report a case of demyelinating polyneuropathy associated with the use of FK 506 in a renal transplant recipient.

Topics: Acute Disease; Acute Kidney Injury; Adult; Demyelinating Diseases; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Neural Conduction; Polyneuropathies; Tacrolimus

FK506-induced polyneuropathies are rarely encountered. We report a case of axonal sensorimotor polyneuropathy in a lung transplant recipient that occurred during a FK506 overdosage. Onset was acute in the form of severe areflexic tetraparesis and resolution was observed after reduction of dosage. Because of increasing use of FK506 in solid organ transplantation, caution should be paid with FK506 dosage monitoring in cases of peripheral nervous system symptoms.

Topics: Dose-Response Relationship, Drug; Drug Overdose; Humans; Immunosuppressive Agents; Lung Transplantation; Male; Middle Aged; Polyneuropathies; Quadriplegia; Tacrolimus

Topics: Adult; Chronic Disease; Demyelinating Diseases; Electromyography; Female; Humans; Immunosuppressive Agents; Polyneuropathies; Prednisolone; Psoriasis; Recurrence; Tacrolimus