SEVERE CENTRAL-NERVOUS-SYSTEM TOXICITY AFTER CHRONIC TREATMENT WITH CYCLOSPORINE

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.