ABSTRACT
The incidence of neurotoxicity from calcineurin inhibitors varies by the organ transplanted. Akinetic mutism is characterized by the inability to perform voluntary movements and express language, without alterations in mental status. This process has been reported in neurotoxicity due to high serum levels of calcineurin inhibitors, but in rare cases, it presents as a form of tacrolimus toxicity after renal transplantation, despite normal serum levels. We report a clinical case of a renal transplant patient in whom reversible acute encephalopathy and akinetic mutism developed. Brain lesions appeared on magnetic resonance imaging, and the condition resolved after the drug was withdrawn.
Subject(s)
Akinetic Mutism/chemically induced , Brain/drug effects , Calcineurin Inhibitors , Immunosuppressive Agents/adverse effects , Kidney Transplantation/immunology , Neurotoxicity Syndromes/etiology , Tacrolimus/adverse effects , Akinetic Mutism/blood , Akinetic Mutism/diagnosis , Akinetic Mutism/pathology , Biomarkers/blood , Brain/metabolism , Brain/pathology , Drug Substitution , Everolimus , Female , Humans , Immunosuppressive Agents/blood , Immunosuppressive Agents/pharmacokinetics , Kidney Transplantation/adverse effects , Magnetic Resonance Imaging , Middle Aged , Neurologic Examination , Neurotoxicity Syndromes/blood , Neurotoxicity Syndromes/diagnosis , Neurotoxicity Syndromes/pathology , Sirolimus/administration & dosage , Sirolimus/analogs & derivatives , Tacrolimus/blood , Tacrolimus/pharmacokinetics , Treatment OutcomeABSTRACT
Forty-six patients who were exposed to sarin consulted our hospital because of darkness of vision, and ocular pain, vomiting, dyspnea and headaches on June 27 and 28, 1994. Eighteen patients were admitted and 4 of them were in the critical state. There were 6 features: 1) depression of plasma cholinesterase activity (17 of 18 patients, 94%), 2) hypokalemia (4/18, 22%), 3) depression of triglyceride (12/18, 67%), 4) hypocapnia (5/17, 29%), 5) partial pressure of oxygen (PaO2) <80 mmHg, or requirement of O2 inhalation (15/18, 83%), 6) white blood cells (WBC) >9,000 per mm3 (13/18, 72%). Seventeen patients were discharged from hospital, but one patient is still suffering from akinetic mutism after two years.
