Pseudotumor Cerebri in a Renal Transplant Recipient: A Case Report

Abstract

Purpose: We reported a renal transplant recipient who developed pseudotumor cerebri (PTC) in the course of his follow-up. Method: Case report. Result: A 46-year-old male renal transplant recipient visited our clinic with the chief complaint of transient blurred vision intermittently on both eyes for 2 weeks. He underwent a smooth renal transplantation 8 months ago, and he had no hypertension or diabetic history. Our ophthalmologic examination showed that he had bilateral severe papilledema (grade Ⅳ), visual field defect, and color sense disturbance. He had good visual acuity and no other ocular abnormality. His orbital computed tomography (CT) showed the typical target sign and the rail tract sign on both optic nerves, but there was no mass lesion. The lumbar puncture performed by the neurologists showed the high initial intracranial pressure (ICP) (300 mmH2O) and the normal cerebrospinal fluid (CSF) content. The magnetic resonance venography (MRV) study for the head strongly suggested the superior saggital sinus (SSS) thrombosis at the distal end. Therefore, the neurologist started the treatment of Diamox, Coumadin and multiple lumbar punctures. Besides, due to the adverse effect of Tacrolimus was also suspected in the pathogenesis of the patient's PTC, Cyclosporine was given in substitute of his immunosuppressive therapy by the nephrologist. The patient's ICP returned to normal level after these treatments about 2 months later. Afterwards, this patient only suffered from a minor attack of right leg deep vein thrombosis and remained stable since then. 7 months later, the papilledema of optic discs was completely resolved as well as the visual field defect and the color sense disturbance. Conclusion: The thrombotic tendency occurred following renal transplanttation or the use of Tacrolimus or Cyclosporin for immunosuppressive treatment may lead to PTC. Patients with renal transplant might develop rare eye conditions such as headache, visual disturbance or papilledema. Prompt diagnosis and management of this rare and serious but treatable condition depends on the ophthalmologist's alertness.