Parkinsonism During Cyclosporine Treatment in Liver Transplantation: An Unusual Case Report

doi:10.1016/j.transproceed.2008.07.053

Transplantation Proceedings

Volume 40, Issue 8, October 2008, Pages 2823-2824

https://doi.org/10.1016/j.transproceed.2008.07.053 Get rights and content

Abstract

Objectives

Cyclosporine (CyA) has been associated with various neurological reactions but parkinsonism is not generally recognized as a nervous system side effect. We describe herein a rare case, in that the patient developed parkinsonism with rest tremor after receiving CyA following orthotopic liver transplantation (OLT).

Methods

The patient was a 42-year-old man who had liver cirrhosis with hepatitis C. We performed OLT because of liver failure and started immunosuppressive therapy with CyA + methylprednisolone + CD25 antibody. Ten days after OLT, he developed parkinsonism with a rest tremor. The patient did not have a pre-existent neurological disorder, and had not received significant amounts of dopamine-blocking drugs.

Results

We administered levodopa with marked improvement. Three days after that event, the neurologist suggested the possibility of drug-induced parkinsonism. We converted the immunosuppressive drug from CyA to tacrolimus. After that, the symptom disappeared. At 75 days after OLT, he was discharged with no neurological medication and now he is completely recovered.

Conclusion

We think that parkinsonism may be an occasional consequence of CyA because of its relation to withdrawal of the drug and the lack of another evident cause.

Section snippets

Case Report

From July 1991 to June 2007, we performed 111 OLTs, including 7 cases of liver cirrhosis due to hepatitis C among whom 4 patients were prescribed immunosuppressive therapy with CyA. Herein we have described a patient who had liver cirrhosis with hepatitis C and developed parkinsonism during CyA therapy after OLT.

He was a 42-year-old man who 11 years prior experienced hepatitis and 2 years ago was diagnosed with liver cirrhosis due to hepatitis C. We performed a cadaveric donor liver

Results

We administered a sedative drug to this patient. Then the neurologist administered levodopa and he improved markedly. Three days after that event, the neurologist suggested the possibility of drug-induced parkinsonism; we converted the immunosuppressive drug from CyA to tacrolimus. After that, the symptom disappeared (Fig 1). Seventy-five days after OLT he was discharged with no neurological medication. He has now completely recovered.

Discussion

CyA has been associated with various neurological side effects, including headaches, postural tremor, seizures, encephalopathy, and visual hallucinations.1, 2 But parkinsonism is not generally recognized as a nervous system side effect of CyA. In 1996, Wasserstein et al first reported 2 cases of parkinsonism during CyA treatment following allogeneic bone marrow transplantation.² In 2002, Kim et al reported 1 case of parkinsonism during CyA treatment following renal transplantation.³ But, as

References (3)

H.C. Kim et al.
Parkinsonism during cyclosporine treatment in renal transplantation
Nephrol Dial Transplant
(2002)

There are more references available in the full text version of this article.

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: Supported by Grants-in–Aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan, and from the Ministry of Welfare of Japan, and by a grant from Tohoku University Graduate School of Medicine.

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Case reportLiverParkinsonism During Cyclosporine Treatment in Liver Transplantation: An Unusual Case Report

Abstract

Objectives

Methods

Results

Conclusion

Section snippets

Case Report

Results

Discussion

Nephrol Dial Transplant

Case report
Liver
Parkinsonism During Cyclosporine Treatment in Liver Transplantation: An Unusual Case Report