Turkiye Klinikleri Journal of Ophthalmology

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Renal Transplantasyon Sonrası Takrolimus ile İndüklenen Bilateral Optik Nöropati: Olgu Sunumu ve Literatür Taraması
Tacrolimus Induced Bilateral Optic Neuropathy After Renal Transplantation: Case Report and Literature Review
Berru YARGIa, Semra AKKAYA TURHANa, Muhsin ERASLANa
aMarmara Üniversitesi Tıp Fakültesi, Göz Hastalıkları ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2020;29(4):339-44
doi: 10.5336/ophthal.2020-77549
Article Language: TR
Full Text
ÖZET
 Renal transplantasyon sonrası takrolimus kullanan hastada gelişen bilateral optik nöropati ve tek taraflı işitme kaybı olgusu literatür eşliğinde incelenmiştir. Elli yedi yaşındaki erkek hasta, 15 gündür olan her 2 gözde bulanık görme ve 1 aydır olan sağ kulakta işitme kaybı şikâyetiyle başvurdu. Yirmi yıldır, böbrek nakli sonrası takrolimus kullandığı öğrenildi. Oftalmolojik muayenesinde görme keskinliği (GK) ondalık cinsinden sağda tashihli 0,2, solda ise ışık hissi seviyesindeydi. Solda afferent pupilla defekti olan hastanın yapılan fundus incelemesinde her 2 optik disk soluktu. Nonarteritik iskemik optik nöropati ön tanısıyla 1 gr/gün intravenöz (IV) pulse metilprednizolon tedavisi önerildi. Takrolimus kesilerek everolimus başlandı. Birinci hafta muayenesinde GK 0,2/30 cmps olan hastanın işitme testinde ise kısmi iyileşme görüldü. Sonuç olarak, takrolimus iyi tolere edilen bir immünsupresif ajan olmasına rağmen görme kaybı oldukça ciddi bir komplikasyondur. Kalsinörin inhibitörü kullanan hastalarda görme kaybı, işitme kaybı gibi semptomlar geliştiğinde, ilacın kesilmesi ve uygun hastalarda sistemik steroid tedavisi uygulanması, semptomlarda bir miktar iyileşme sağlayabilir.

Anahtar Kelimeler: Optik nöropati; nörosensöriyel işitme kaybı; takrolimus; renal transplantasyon
ABSTRACT
 A case of tacrolimus induced bilateral optic-neuropathy and unilateral hearing-loss after renal transplantation has been studied with the review of literature. A 57-year-old male patient presented with 15-day blurred vision in both eyes and 1-month hearingloss in the right-ear. He has been using tacrolimus for 20-years after renal transplantation. The visual acuity was 0.2 decrimal in the righteye and light perception in the left-eye. The relative afferent pupillary defect was noted in the left-eye. Both optic discs were pale. Ischemic optic neuropathy was diagnosed and planned 1g/day pulse methylprednisolone treatment and tacrolimus was switched to everolimus. Visual acuity was 0.2/30 cm counting fingers at the 1st-week. Partial improvement was observed in the hearing test. Although tacrolimus is a well-tolerated immunosuppressive-agent, vision-loss is a serious complication. When symptoms such as vision-loss, hearing-loss develop in patients who use calcineurin inhibitors, discontinuation of the drug and administration of systemic steroids may provide some improvement.

Keywords: Optic neuropathy; neurosensory hearing loss; tacrolimus; renal transplantation
REFERENCES:
  1. Kapoor KG, Mirza SN, Gonzales JA, Gibran SK. Visual loss associated with tacrolimus : case report and review of the literature. Cutan Ocul Toxicol. 2010;29(2):137-9.[Crossref] [PubMed] 
  2. Lanzetta P, Monaco P. Major ocular complications after organ transplantation. Indian J Ophthalmol. 2004;52(2):95-7. [PubMed] 
  3. Anghel D, Tanasescu R, Campeanu A, Lupescu I, Podda G, Bajenaru O, et al. Neurotoxicity of immunosuppressive therapies in organ transplantation. Maedica (Bucur). 2013;8(2):170-5. [PubMed] 
  4. Venneti S, Moss HE, Levin MH, Vagefi MR, Brozena SC, Pruitt AA, et al. Asymmetric bilateral demyelinating optic neuropathy from tacrolimus toxicity. J Neurol Sci. 2011;15;301(1-2):112-5.[Crossref] [PubMed] 
  5. Shutter LA, Green JP, Newman NJ, Hooks MA, Gordon RD. Cortical blindness and white matter lesions in a patient receiving FK506 after liver transplantation. Neurology. 1993;43(11):2417-8.[Crossref] [PubMed] 
  6. Devine SM, Newman NJ, Siegel JL, Joseph GJ, Geis TC, Schneider JA, et al. Tacrolimus (FK506)-induced cerebral blindness following bone marrow transplantation. Bone Marrow Transplant. 1996;18(3):569-72. [PubMed] 
  7. Steg RE, Kessinger A, Wszolek ZK. Cortical blindness and seizures in a patient receiving FK506 after bone marrow transplantation. Bone Marrow Transplant. 1999;23(9):959-62. [Crossref] [PubMed] 
  8. Wong R, Beguelin GZ, de Lima M, Giralt SA, Hosing C, Ippoliti C, et al. Tacrolimus-associated posterior reversible encephalopathy syndrome after allogeneic haematopoietic stem cell transplantation. Br J Haematol. 2003;122(1):128-34. [Crossref] [PubMed] 
  9. McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189(4):904-12.[Crossref] [PubMed] 
  10. Kommana SS, Bains U, Fasula V, Henderer J. A case of tacrolimus-induced posterior reversible encephalopathy syndrome initially presenting as a bilateral optic neuropathy. Case Rep Ophthalmol. 2019;23;10(1):140-4.[Crossref] [PubMed] [PMC] 
  11. Gupta M, Bansal R, Beke N, Gupta A. Tacrolimus-induced unilateral ischaemic optic neuropathy in a non-transplant patient. BMJ Case Rep. 2012;21;2012:bcr2012006718.[Crossref] [PubMed] [PMC] 
  12. Brazis PW, Spivey JR, Bolling JP, Steers JL. A case of bilateral optic neuropathy in a patient on tacrolimus (FK506) therapy after liver transplantation. Am J Ophthalmol. 2000;129(4):536-8.[Crossref] [PubMed] 
  13. Lake DB, Poole TRG. Tacrolimus. Br J Ophthalmol. 2003;87(1):121-2.[Crossref] [PubMed] [PMC] 
  14. Ascaso FJ, Mateo J, Huerva V, Cristóbal JA. Unilateral tacrolimus-associated optic neuropathy after liver transplantation. Cutan Ocul Toxicol. 2012;31(2):167-70.[Crossref] [PubMed] 
  15. Yun J, Park KA, Oh SY. Bilateral ischemic optic neuropathy in a patient using tacrolimus (FK506) after liver transplantation. Transplantation. 2010;27;89(12):1541-2.[Crossref] [PubMed] 
  16. Kessler L, Lucescu C, Pinget M, Charton MN, Mutschler V, Wolf P, et al. Tacrolimus-associated optic neuropathy after pancreatic islet transplantation using a sirolimus/tacrolimus immunosuppressive regimen. Transplantation. 2006;27;81(4):636-7.[Crossref] [PubMed] 
  17. Rasool N, Boudreault K, Lessell S, Prasad S, Cestari DM. Tacrolimus optic neuropathy. J Neuroophthalmol. 2018;38(2):160-6.[Crossref] [PubMed] 
  18. Akagi T, Manabe S, Ishigooka H. A case of cyclosporine-induced optic neuropathy with a normal therapeutic level of cyclosporine. Jpn J Ophthalmol. 2010;54(1):102-4. [Crossref] [PubMed] 
  19. Avery R, Jabs DA, Wingard JR, Vogelsang G, Saral R, Santos G, et al. Optic disc edema after bone marrow transplantation. Possible role of cyclosporine toxicity. Ophthalmology. 1991;98(8):1294-301.[Crossref] [PubMed] 
  20. Canovai E, Cassiman C, Ceulemans LJ, Demaerel P, Sainz-Barriga M, Jochmans I, et al. Tacrolimus-induced optic neuropathy after multivisceral transplantation. Transplant Direct. 2019;24;6(1):e516.[Crossref] [PubMed] [PMC] 
  21. Alnahdi MA, Al Malik YM. Delayed tacrolimus-induced optic neuropathy. Neurosciences (Riyadh). 2019;24(4):324-6.[Crossref] [PubMed] 
  22. Yanagimachi M, Naruto T, Tanoshima R, Kato H, Yokosuka T, Kajiwara R, et al. Influence of CYP3A5 and ABCB1 gene polymorphisms on calcineurin inhibitor-related neurotoxicity after hematopoietic stem cell transplantation. Clin Transplant. 2010;24(6):855-61.[Crossref] [PubMed] 
  23. Lewis MB, Howdle PD. Neurologic complications of liver transplantation in adults. Neurology. 2003;11;61(9):1174-8. [Crossref] [PubMed] 
  24. Marioni G, Perin N, Tregnaghi A, Bellemo B, Staffieri A, de Filippis C, et al. Progressive bilateral sensorineural hearing loss probably induced by chronic cyclosporin a treatment after renal transplantation for focal glomerulosclerosis. Acta Otolaryngol. 2004;124(5):603-7. [Crossref] [PubMed] 
  25. Norman K, Bonatti H, Dickson RC, Aranda-Michel J. Sudden hearing loss associated with tacrolimus in a liver transplant recipient. Transpl Int. 2006;19(7):601-3.[Crossref] [PubMed] 

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