A presentation of posterior reversible encephalopathy syndrome after heart transplantation: a case report and review of literature
Abstract Background Posterior reversible encephalopathy syndrome is a rare disorder encompassing multiple neurological symptoms usually corroborated by specific neuro magnetic resonance imaging features. Posterior reversible encephalopathy syndrome may be triggered by multiple clinical situations su...
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2025-08-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-025-05498-3 |
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| author | Daniel Grandmougin Tristan Ehrlich Yihua Liu Juliette Piccoli Pan Dan Elodie Phamisith Francesco Ferraro Cristina Sirbu Irina Klemina Emmanuelle Schmitt Ismaël Yahia Michael Massin Benjamin Lefèvre Carine Thivilier Fabrice Vanhuyse Stéphane Zuily Juan-Pablo Maureira |
| author_facet | Daniel Grandmougin Tristan Ehrlich Yihua Liu Juliette Piccoli Pan Dan Elodie Phamisith Francesco Ferraro Cristina Sirbu Irina Klemina Emmanuelle Schmitt Ismaël Yahia Michael Massin Benjamin Lefèvre Carine Thivilier Fabrice Vanhuyse Stéphane Zuily Juan-Pablo Maureira |
| author_sort | Daniel Grandmougin |
| collection | DOAJ |
| description | Abstract Background Posterior reversible encephalopathy syndrome is a rare disorder encompassing multiple neurological symptoms usually corroborated by specific neuro magnetic resonance imaging features. Posterior reversible encephalopathy syndrome may be triggered by multiple clinical situations such as blood pressure fluctuations, ischemic stroke, inflammatory and autoimmune disorders, renal failure, pre-eclampsia and eclampsia, hematopoietic stem cell transplantation, cytotoxic drugs, calcineurin inhibitors (cyclosporine A), and other immunosuppressants, as well as a wide range of surgical procedures (mainly cranial and solid organ transplantation). Although rare after cardiac transplantation, posterior reversible encephalopathy syndrome remains a major adverse event among feared complications promoted by use of immunosuppressive drugs. Clinical symptomatology, imaging features, and evolution of posterior reversible encephalopathy syndrome as well therapeutic strategy and identification of contributing factors will be discussed on the basis of our experience and data from literature review. Case presentation We report the case of a 59-year-old white male patient who was diagnosed with posterior reversible encephalopathy syndrome 3 months after cardiac transplantation. Neurologic complications gradually worsened within weeks after transplantation from an immediate postoperative paraparesis to seizures and coma requiring specific management in the intensive care unit. Initial brain computed tomography and magnetic resonance imaging were not contributive. Ultimately, magnetic resonance imaging characteristics of posterior reversible encephalopathy syndrome gradually appeared 10 weeks after transplantation and were concomitant with epileptic seizures, coma, and occurrence of Shiga toxin-producing Escherichia coli-hemolytic–uremic syndrome in a context of blood pressure variations and administration of cyclosporine A. Conclusion This case highlighted the necessity for clinicians to be familiar with posterior reversible encephalopathy syndrome to prevent misdiagnosis and optimize neurological outcomes. In addition, it emphasized the underlying non-dose-dependent neurotoxicity of cyclosporine A. |
| format | Article |
| id | doaj-art-e1c9e90ade884e2ab854b77020116708 |
| institution | Kabale University |
| issn | 1752-1947 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj-art-e1c9e90ade884e2ab854b770201167082025-08-24T11:31:35ZengBMCJournal of Medical Case Reports1752-19472025-08-0119111310.1186/s13256-025-05498-3A presentation of posterior reversible encephalopathy syndrome after heart transplantation: a case report and review of literatureDaniel Grandmougin0Tristan Ehrlich1Yihua Liu2Juliette Piccoli3Pan Dan4Elodie Phamisith5Francesco Ferraro6Cristina Sirbu7Irina Klemina8Emmanuelle Schmitt9Ismaël Yahia10Michael Massin11Benjamin Lefèvre12Carine Thivilier13Fabrice Vanhuyse14Stéphane Zuily15Juan-Pablo Maureira16Department of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Neurology, Hôpital Central. CHRU-NancyDepartment of Neuroradiology, Hôpital Central. CHRU-NancyDepartment of Neuroradiology, Hôpital Central. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyDepartment of Infectious and Tropical Diseases, Bâtiment des Spécialités Médicales Philippe Canton. CHRU NancyDepartment of Critical Care and Reanimation, ILCV Louis Mathieu, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyNational Referral Center for Rare Vascular and Systemic Autoimmune Diseases, ILCV Louis Mathieu. CHRU-NancyDepartment of Cardiac Surgery and Heart Transplantation, ILCV Louis Mathieu. CHRU-NancyAbstract Background Posterior reversible encephalopathy syndrome is a rare disorder encompassing multiple neurological symptoms usually corroborated by specific neuro magnetic resonance imaging features. Posterior reversible encephalopathy syndrome may be triggered by multiple clinical situations such as blood pressure fluctuations, ischemic stroke, inflammatory and autoimmune disorders, renal failure, pre-eclampsia and eclampsia, hematopoietic stem cell transplantation, cytotoxic drugs, calcineurin inhibitors (cyclosporine A), and other immunosuppressants, as well as a wide range of surgical procedures (mainly cranial and solid organ transplantation). Although rare after cardiac transplantation, posterior reversible encephalopathy syndrome remains a major adverse event among feared complications promoted by use of immunosuppressive drugs. Clinical symptomatology, imaging features, and evolution of posterior reversible encephalopathy syndrome as well therapeutic strategy and identification of contributing factors will be discussed on the basis of our experience and data from literature review. Case presentation We report the case of a 59-year-old white male patient who was diagnosed with posterior reversible encephalopathy syndrome 3 months after cardiac transplantation. Neurologic complications gradually worsened within weeks after transplantation from an immediate postoperative paraparesis to seizures and coma requiring specific management in the intensive care unit. Initial brain computed tomography and magnetic resonance imaging were not contributive. Ultimately, magnetic resonance imaging characteristics of posterior reversible encephalopathy syndrome gradually appeared 10 weeks after transplantation and were concomitant with epileptic seizures, coma, and occurrence of Shiga toxin-producing Escherichia coli-hemolytic–uremic syndrome in a context of blood pressure variations and administration of cyclosporine A. Conclusion This case highlighted the necessity for clinicians to be familiar with posterior reversible encephalopathy syndrome to prevent misdiagnosis and optimize neurological outcomes. In addition, it emphasized the underlying non-dose-dependent neurotoxicity of cyclosporine A.https://doi.org/10.1186/s13256-025-05498-3Posterior reversible encephalopathy syndromeHemolytic uremic syndromeShiga toxin-producing Escherichia coliCalcineurin inhibitorsCyclosporine ATacrolimus |
| spellingShingle | Daniel Grandmougin Tristan Ehrlich Yihua Liu Juliette Piccoli Pan Dan Elodie Phamisith Francesco Ferraro Cristina Sirbu Irina Klemina Emmanuelle Schmitt Ismaël Yahia Michael Massin Benjamin Lefèvre Carine Thivilier Fabrice Vanhuyse Stéphane Zuily Juan-Pablo Maureira A presentation of posterior reversible encephalopathy syndrome after heart transplantation: a case report and review of literature Journal of Medical Case Reports Posterior reversible encephalopathy syndrome Hemolytic uremic syndrome Shiga toxin-producing Escherichia coli Calcineurin inhibitors Cyclosporine A Tacrolimus |
| title | A presentation of posterior reversible encephalopathy syndrome after heart transplantation: a case report and review of literature |
| title_full | A presentation of posterior reversible encephalopathy syndrome after heart transplantation: a case report and review of literature |
| title_fullStr | A presentation of posterior reversible encephalopathy syndrome after heart transplantation: a case report and review of literature |
| title_full_unstemmed | A presentation of posterior reversible encephalopathy syndrome after heart transplantation: a case report and review of literature |
| title_short | A presentation of posterior reversible encephalopathy syndrome after heart transplantation: a case report and review of literature |
| title_sort | presentation of posterior reversible encephalopathy syndrome after heart transplantation a case report and review of literature |
| topic | Posterior reversible encephalopathy syndrome Hemolytic uremic syndrome Shiga toxin-producing Escherichia coli Calcineurin inhibitors Cyclosporine A Tacrolimus |
| url | https://doi.org/10.1186/s13256-025-05498-3 |
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