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Renal Transplantasyon Sonrası Takrolimus ile İndüklenen Bilateral Optik Nöropati: Olgu Sunumu ve Literatür Taraması
Tacrolimus Induced Bilateral Optic Neuropathy After Renal Transplantation: Case Report and Literature Review
Turkiye Klinikleri J Ophthalmol. 2020;29(4):339-44
doi: 10.5336/ophthal.2020-77549
Makale Dili: TR
Tam Metin
ÖZET
Renal transplantasyon sonrası takrolimus kullanan hastada gelişen bilateral optik nöropati ve tek taraflı işitme 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 kaybı şikâyetiyle başvurdu. Yirmi yıldır, böbrek nakli sonrası takrolimus kullandığı 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 incelemesinde her 2 optik disk soluktu. Nonarteritik iskemik optik nöropati ön tanısıyla 1 gr/gün intravenöz (IV) pulse metilprednizolon tedavisi önerildi. Takrolimus kesilerek everolimus başlandı. Birinci hafta muayenesinde GK 0,2/30 cmps olan hastanın işitme testinde ise kısmi iyileşme görüldü. Sonuç olarak, takrolimus iyi tolere edilen bir immünsupresif 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.
Anahtar Kelimeler: Optik nöropati; nörosensöriyel işitme kaybı; takrolimus; renal transplantasyon
Renal transplantasyon sonrası takrolimus kullanan hastada gelişen bilateral optik nöropati ve tek taraflı işitme 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 kaybı şikâyetiyle başvurdu. Yirmi yıldır, böbrek nakli sonrası takrolimus kullandığı 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 incelemesinde her 2 optik disk soluktu. Nonarteritik iskemik optik nöropati ön tanısıyla 1 gr/gün intravenöz (IV) pulse metilprednizolon tedavisi önerildi. Takrolimus kesilerek everolimus başlandı. Birinci hafta muayenesinde GK 0,2/30 cmps olan hastanın işitme testinde ise kısmi iyileşme görüldü. Sonuç olarak, takrolimus iyi tolere edilen bir immünsupresif 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.
Anahtar Kelimeler: Optik nöropati; nörosensöriyel işitme kaybı; takrolimus; renal transplantasyon
ABSTRACT
A case of tacrolimus induced bilateral optic-neuropathy and unilateral hearing-loss after renal transplantation has been studied with the review of literature. A 57-year-old male patient presented with 15-day blurred vision in both eyes and 1-month hearingloss in the right-ear. He has been using tacrolimus for 20-years after renal transplantation. The visual acuity was 0.2 decrimal in the righteye 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 methylprednisolone 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 develop in patients who use calcineurin inhibitors, discontinuation of the drug and administration of systemic steroids may provide some improvement.
Keywords: Optic neuropathy; neurosensory hearing loss; tacrolimus; renal transplantation
A case of tacrolimus induced bilateral optic-neuropathy and unilateral hearing-loss after renal transplantation has been studied with the review of literature. A 57-year-old male patient presented with 15-day blurred vision in both eyes and 1-month hearingloss in the right-ear. He has been using tacrolimus for 20-years after renal transplantation. The visual acuity was 0.2 decrimal in the righteye 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 methylprednisolone 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 develop in patients who use calcineurin inhibitors, discontinuation of the drug and administration of systemic steroids may provide some improvement.
Keywords: Optic neuropathy; neurosensory hearing loss; tacrolimus; renal transplantation
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