M. Garciaescrig et al., SEVERE CENTRAL-NERVOUS-SYSTEM TOXICITY AFTER CHRONIC TREATMENT WITH CYCLOSPORINE, Clinical neuropharmacology, 17(3), 1994, pp. 298-302
Severe neurologic complications following treatment with cyclosporine
are uncommon. They tend to occur during the first month of treatment a
nd disappear after withdrawal or reduction of the dose of the drug. We
report the case of a man who underwent a liver transplantation and su
bsequently developed severe central nervous system toxicity. After two
years receiving cyclosporine, he presented with a brachial monoparesi
s and a complex visual disturbance. Symptoms slowly worsened during fo
ur months. On admission, he had confusion and seizures. Multiple areas
of T2 prolongation, located in cerebral white matter, were seen on ma
gnetic resonance imaging (MRT). Symptoms partially improved after cycl
osporine withdrawal, but brain lesions shown on MRI persisted in seria
l imaging studies after two years of follow-up. We discuss the mechani
sms that have been proposed to explain this clinical picture. Severe c
yclosporine-associated neurotoxicity can also occur after chronic admi
nistration, even with serum levels in therapeutic range.