Publication: Renal Transplantasyon Sonrası Takrolimus ile İndüklenen Bilateral Optik Nöropati: Olgu Sunumu ve Literatür Taraması
Abstract
Renal transplantasyon sonrası takrolimus kullanan hastada ge-lişen bilateral optik nöropati ve tek taraflıişitme kaybı olgusu literatür eşliğinde incelenmiştir. Elli yedi yaşındaki erkek hasta, 15 gündür olan her 2 gözde bulanık görme ve 1 aydır olan sağ kulakta işitme kaybışi-kâyetiyle başvurdu. Yirmi yıldır, böbrek nakli sonrası takrolimus kul-landığı öğrenildi. Oftalmolojik muayenesinde görme keskinliği (GK) ondalık cinsinden sağda tashihli 0,2, solda ise ışık hissi seviyesindeydi. Solda afferent pupilla defekti olan hastanın yapılan fundus inceleme-sinde her 2 optik disk soluktu. Nonarteritik iskemik optik nöropati ön tanısıyla 1 gr/gün intravenöz (IV) pulse metilprednizolon tedavisi öne-rildi. Takrolimus kesilerek everolimus başlandı. Birinci hafta muaye-nesinde GK 0,2/30 cmps olan hastanın işitme testinde ise kısmiiyileşme görüldü. Sonuç olarak, takrolimus iyi tolere edilen bir im-münsupresif ajan olmasına rağmen görme kaybı oldukça ciddi bir komplikasyondur. Kalsinörin inhibitörü kullanan hastalarda görme kaybı, işitme kaybı gibi semptomlar geliştiğinde, ilacın kesilmesi ve uygun hastalarda sistemik steroid tedavisi uygulanması, semptomlarda bir miktar iyileşme sağlayabilir.
A case of tacrolimus induced bilateral optic-neuropa-thy and unilateral hearing-loss after renal transplantation has been studied with the review of literature. A 57-year-old male patient pre-sented with 15-day blurred vision in both eyes and 1-month hearing-loss in the right-ear. He has been using tacrolimus for 20-years after renal transplantation. The visual acuity was 0.2 decrimal in the right-eye and light perception in the left-eye. The relative afferent pupillary defect was noted in the left-eye. Both optic discs were pale. Ischemic optic neuropathy was diagnosed and planned 1g/day pulse methyl-prednisolone treatment and tacrolimus was switched to everolimus. Visual acuity was 0.2/30 cm counting fingers at the 1st-week. Partial improvement was observed in the hearing test. Although tacrolimus is a well-tolerated immunosuppressive-agent, vision-loss is a serious complication. When symptoms such as vision-loss, hearing-loss de-velop in patients who use calcineurin inhibitors, discontinuation of the drug and administration of systemic steroids may provide some improvement.
A case of tacrolimus induced bilateral optic-neuropa-thy and unilateral hearing-loss after renal transplantation has been studied with the review of literature. A 57-year-old male patient pre-sented with 15-day blurred vision in both eyes and 1-month hearing-loss in the right-ear. He has been using tacrolimus for 20-years after renal transplantation. The visual acuity was 0.2 decrimal in the right-eye and light perception in the left-eye. The relative afferent pupillary defect was noted in the left-eye. Both optic discs were pale. Ischemic optic neuropathy was diagnosed and planned 1g/day pulse methyl-prednisolone treatment and tacrolimus was switched to everolimus. Visual acuity was 0.2/30 cm counting fingers at the 1st-week. Partial improvement was observed in the hearing test. Although tacrolimus is a well-tolerated immunosuppressive-agent, vision-loss is a serious complication. When symptoms such as vision-loss, hearing-loss de-velop in patients who use calcineurin inhibitors, discontinuation of the drug and administration of systemic steroids may provide some improvement.