Case Report

Fatal outcome due to cyclosporine neurotoxicity with associated pathological findings

  • Bone Marrow Transplantation volume 23, pages 191193 (1999)
  • doi:10.1038/sj.bmt.1701542
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Abstract

We present a case of death likely to be directly due to cyclosporine (CsA) neurotoxicity. To date, there have been no reports of deaths directly due to CsA neuro- toxicity, nor has an associated histological lesion been described independent of confounding processes. A 54-year-old male received an HLA-matched-unrelated BMT for CML. He developed progressive encephalo- pathy and on day +79 had a generalized seizure. All CSF studies were negative for infectious causes. MRI revealed diffuse, symmetrical white matter abnormalities located in the occipital sub-cortex, thalamus, mid brain, pons, and cerebellum which were typical of CsA toxicity. The patient died of central respiratory failure within 72 h of discontinuing CsA. Autopsy revealed diffuse patchy white matter edema and astrocytic injury without evidence of axonopathy, demyelination, microvascular injury, or infectious/inflammatory process. This case demonstrates previously undescribed lethal CsA neurotoxicity and may reveal an associated primary pathological lesion.

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Affiliations

  1. Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    • AK Gopal
  2. Department of Medicine, Division of Medical Oncology, University of Washington, WA, USA

    • AK Gopal
  3. Department of Pathology, University of Washington, WA, USA

    • DR Thorning
    •  & AL Back
  4. Veterans Administration, Puget Sound Health Care System, Seattle, WA, USA

    • DR Thorning
    •  & AL Back

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Corresponding author

Correspondence to AK Gopal.