DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20182731

Acute schizophrenia-like psychotic disorder associated with immunosuppressive agent use three years after renal transplantation: a case report

Okwudili N. K. Obayi

Abstract


Tacrolimus is a potent immunosuppressive agent used to prevent graft-versus-host disease after organ transplantation. Though a beneficial drug that contributes in the post-transplant life of patients, it comes with various side effects including, though rarely, psychiatric manifestations such as psychosis. Reported here is the case of a 21 year old lady with no prior psychiatry history with apparent tacrolimus-induced schizophrenia-like psychosis. Withdrawal of the immunosuppressant led her to full recovery from the mental problem. To the best of my knowledge, there are only few reports that describe psychosis induced by tacrolimus but none of such reports is from Nigeria, a country with increasing demand for kidney transplant. Clinicians are reminded to regularly watch out for mental status changes in post-transplant patients as early identification of any aberration with immediate reduction of the dosage or substitution of the drug would save both the patient and the already emotionally and financially-stressed family from further distress.


Keywords


Tacrolimus, Psychosis, Post-transplant

Full Text:

PDF

References


Suleymanlar G, Serdengecti K, Erek E. Epidemiology of end-stage renal disease in Turkiye. Turkiye Klinikleri J Int Med Sci. 2005;1(21):1–8.

De Pasquale C, Veroux M, Indelicato L, Sinagra N, Giaquinta A, Fornaro M, et al. Psychopathological aspects of kidney transplantation: efficacy of a multidisciplinary team. World J Transplant. 2014;4(4):267–75.

Pawar AA, Rathod J, Chaudhury S, Saxena SK, Saldanha D, Ryali VSSR, et al. Cognitive and emotional effects of renal transplantation. Indian J Psychiatr. 2006;48(1):21–6.

Wu Q, Marescaux C, Wolffetal V. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. European Neurol. 2010;64(3):169–77.

Ozawa T. Effects of FK506 on Ca2+ release channels (review). Perspectives Med Chem. 2008;2:51–5.

Wallemacq P, Armstrong VW, Brunetetal M. Opportunities to optimize tacrolimus therapy in solid organ transplantation: report of the european consensus conference. Ther Drug Monitoring. 2009;31(2):139–52.

Bersani G, Marino P, Valeriani G, Cuoco V, Zitelli C, Melcore C, et al. Manic-like psychosis associated with elevated trough tacrolimus blood concentrations 17 years after kidney transplant. Case Rep Psych. 2013;2013:26395.

Chegounchi M, Hanna MG, Neild GH. Progressive neurological disease induced by tacrolimus in a renal transplant recipient: case presentation. BMC Nephrol. 2006;7(7).

Marco S, Cecilia F, Patrizia B. Neurologic complications after solid organ transplantation. Transplant Int. 2009;22:269-78.

Astellas Pharma. Prograf full prescribing information. Deerfield, IL: Astellas Pharma US Inc. 2015. Available at: http://www.astellas.us/docs/

prograf.pdf. Accessed 10 March 2018.

Chopra A, Das P, Rai A, Kuppuswamy PS, Li X, Philbrick K, et al. Catatonia as a manifestation of tacrolimus-induced neurotoxicity in organ transplant patients: A case series. Gen Hosp Psychiatry. 2012;34:209.

Krishna N, Chiappelli J, Fischer BA, Knight S. Tacrolimus-induced paranoid delusions and fugue-like state. Gen Hosp Psychiatry. 2013;35:327.

Corruble E, Buhl C, Esposito D, Schuster JP, Chouinard VA, Hardy P, Chouinard G. Psychosis associated with elevated trough tacrolimus blood concentrations after combined kidney-pancreas transplant. Intl J Neuropsychopharmacol. 2006;9:493–4.

Jain S, Liao YH, Li D. Tacrolimus induced mania with psychosis – a case report. Open Access Text. 2018. doi: 10.15761/CCRR.1000187.

Gok F, Eroglu MZ. Acute psychotic disorder associated with immunosuppressive agent use after renal transplantation: a case report. Psy Clin Psychopharmacol. 2017;27(3):320-2.

Beresford TP. Neuropsychiatric complications of liver and other solid organ transplantation. Liver Transpl. 2001;7:36-45.

Sehgal VN, Srivastava G, Dogra S. Tacrolimus in dermatology - pharmacokinetics, mechanism of action, drug interactions, dosages, and side effects: part I. Skin Med. 2008;7(1):27–30.

DiMartini AF, Trzepacz PT, Davis SR. Prospective study of FK506 side effects: anxiety or akathisia? Biol Psychiat. 1996;40:407-11.

Venkataramanan R, Shaw LM, Sarkozi L, Mullins R, Pirsch J, MacFarlane G, Scheller D, Ersfeld D, Frick M, Fitzsimmons WE, et al. Clinical utility of monitoring tacrolimus blood concentration in liver transplant patients. J Clin Pharmacol. 2001;41:542–51.

Varghese J, Reddy MS, Venugopal K, Perumalla R, Narasimhan G, Arikichenin O et al. Tacrolimus-related adverse effects in liver transplant recipients: Its association with trough concentrations. Indian J Gastroenterol. 2014;33(3):219–25.

Memetoglu ME, Yalcın O, Erbasan O. Acute psychotic disorder after cardiac transplantation possibly associ-ated with cyclosporine and sertraline treatment: a case report. Düşünen Adam J Psychiatry Neurol Sci. 2013;26:111–4.