Parkinsonism During Cyclosporine Treatment in Liver Transplantation: An Unusual Case Report
Parkinsonism During Cyclosporine Treatment in Liver Transplantation: An Unusual Case Report
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DOI：
10.1016/j.transproceed.2008.07.053
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发表时间：
2008-10-01
影响因子：
0.9
通讯作者：
Satomi, S.
中科院分区：
文献类型：
--
作者：
Miyagi, S.;Sekiguchi, S.;Satomi, S.
目标。环孢素(CyA)与多种神经系统反应有关，但帕金森病并不被普遍认为是神经系统的副作用。我们在此描述一个罕见的病例，患者在原位肝移植(OLT)后接受环磷酰胺治疗后出现帕金森症伴静息性震颤。患者为42岁的丙型肝炎合并肝硬变患者，因肝功能衰竭而行原位肝移植，并用环磷酰胺+甲基强的松龙+CD25抗体进行免疫抑制治疗。肝移植10天后，他患上帕金森症，并伴有静息性震颤。患者没有既往的神经系统疾病，也没有接受过大量的多巴胺阻断药物。我们使用了左旋多巴，取得了显著的改善。事件发生三天后，神经科医生提出了药物诱发帕金森症的可能性。我们将免疫抑制药物从CyA转换为他克莫司。之后，症状消失了。术后75天出院，未用神经内科药物，现已完全康复。我们认为帕金森症可能是CyA的偶然后果，因为它与停药有关，而且缺乏另一个明显的原因。
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.