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Tacrolimus Associated Posterior Reversible Encephalopathy Syndrome (PRES): About a case

The Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological syndrome, it may occur due to a number of causes, including the use of immunosuppressive treatments. It is a rare entity. We report here the occurrence of a PRES syndrome in a patient treated with tacrolimus after liver transplantation, revealed by ocular manifestations associated with intermittent headaches of moderate intensity and tremor in the hands later complicated by a condition epilepticus. The brain scan showed an occipital hematoma in resorption and a lumbar puncture with normal pressure measurement. The brain MRI had objectified on the FLAIR sequence an evocative aspect of reversible posterior encephalopathy in the posterior occipital and parietal territory. Antiepileptic treatment was introduced and tacrolimus was replaced by ciclosporin, given the strong presumption of its involvement in the occurrence of this PRES, with good evolution. The prognosis of PRES is generally favorable under treatment, with a risk of serious sequelae in case of delayed diagnosis justifying that this syndrome must be evoked in front of neurological manifestations in a patient on tacrolimus.