Abstract
A 22-year-old woman with systemic lupus erythematosus (SLE) newly developed hematuria and proteinuria in August 2007, and was admitted to our hospital in February 2008. On admission, chest radiographic examinations and pulmonary function tests revealed that she also had interstitial pneumonia (IP). Findings of renal biopsy were consistent with ISN/RPS IV-G(A) nephritis. IP responded well to prednisolone 45 mg/day, although the proteinuria persisted with such treatment. To ameliorate renal function, tacrolimus was initiated at 3 mg/day. Six days later, generalized convulsion followed by coma developed. She was radiographically diagnosed with reversible posterior leukoencephalopathy syndrome (RPLS) on the basis of signal intensity in T2 FLAIR of brain MRI. She showed the elevations of IL-6, IL-8 and IgG index on the cerebrospinal fluid evaluations suggesting central nervous system (CNS) lupus. Tacrolimus was withheld, and methylprednisolone pulse therapy (1000 mg for 3 days) with anti-epileptics was initiated. On the next day, her level of consciousness became clear. After this episode, she uneventfully showed improvements in CNS vulnerability and renal dysfunction. Renal damage might elevate blood concentration of tacrolimus to induce RPLS together with malfunction of blood-brain barrier seen in CNS lupus. At present time, we concluded the RPLS of this case is a complication of SLE, however, the drug-induced RPLS is not completely neglectable. We should be very careful about tacrolimus administration for patients presumed to have renal dysfunction to prevent further adverse effects.
