Tacrolimus Associated Posterior Reversible Encephalopathy Syndrome – A Case Series and Review

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Susmitha Apuri
Kristin Carlin
Edward Bass
Phuong Thuy Nguyen
John Norman Greene


PRES, Tacrolimus, Acute myeloid leukemia, Bone marrow transplant, Graft versus host disease


Tacrolimus is an immunosuppressive drug mainly used to lower the risk of transplant

rejection in individuals who are post solid organ or hematopoietic transplantation. It is a

macrolide which reduces peptidyl-propyl isomerase activity and inhibits calcineurin, thus

inhibiting T-lymphocyte signal transduction and interleukin-2 (IL-2) transcription. It has

been associated with Posterior Reversible Encephalopathy Syndrome (PRES), a disease

of sudden onset that can present as a host of different symptoms, depending on the

affected area of the brain. While infectious causes of encephalopathy must always be

entertained, the differential diagnosis should also include PRES in the appropriate

context. We report three cases of PRES in patients with acute myeloid leukemia (AML)

placed on tacrolimus after receiving a bone marrow transplant (BMT). The focus of this

review is to enhance clinical recognition of PRES as it is related to an adverse effect of

Tacrolimus in the setting of hematopoietic transplantation.


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