The use of cyclosporine in a boy with a prior episode of posterior encephalopathy

• Published in: Pediatric nephrology (Berlin, West) West), 2005-05, Vol.20 (5), p.657-661
• Main Authors: Nakahara, Chieko, Hasegawa, Naoyuki, Izumi, Isho, Kanemoto, Katsuyosi, Iwasaki, Nobuaki
• Format: Article
• Language: English
• Subjects: Anti-Inflammatory Agents - administration & dosage; Care and treatment; Child; Complications and side effects; Cyclosporine; Cyclosporine - administration & dosage; Cyclosporine - adverse effects; Dosage and administration; Drug therapy; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Magnetic Resonance Imaging; Male; Nephrotic syndrome; Nephrotic Syndrome - drug therapy; Nervous system diseases; Neurotoxicity Syndromes - etiology; Neurotoxicity Syndromes - pathology; Prednisolone - administration & dosage; Recurrence; Remission Induction; Risk factors
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-004-1752-1

We report the case of a 12- year-old Japanese boy who was receiving cyclosporine (Cs A) for steroid-dependent nephrotic syndrome despite a prior episode of Cs A-associated posterior encephalopathy. At the third relapsing of nephrotic syndrome, Cs A was initiated. Eight days after the Cs A therapy, the boy was admitted to the University Hospital of Tsukuba because of generalized convulsion. Magnetic resonance imaging (MRI) showed hyperintense lesions involving the bilateral parieto-occipital region. Cs A was discontinued, and cyclophosphamide was started. The boy had a 6-month drug-free period after the cyclophosphamide treatment and then relapsed three more times in the following 5 months. As the prednisolone dosage could not be decreased to less than 2 mg/kg/48 h, the patient was re-challenged with Cs A 1 1/2 years later. Blood pressure and serum Cs A levels were measured frequently, an anti-hypertensive drug was given, and MRI was done four times to detect hyperintense lesions. He has been receiving Cs A for 9 months, and MRI has revealed no abnormalities. At the latest follow-up, dated 12 April 2004, he was in a remissive state of nephrotic syndrome. This is the first report of giving Cs A to a nephrotic child who had a previous history of Cs A-associated posterior encephalopathy.