ABSTRACT

This report highlights the association of tacrolimus use with acute macular neuroretinopathy (AMN). A 27-year-old woman, a known case of diffuse proliferative membranous glomerulonephritis, developed abnormal body movements, loss of consciousness, and blurring of vision in the left eye, after 3 months of starting tacrolimus. Blood investigations revealed anemia, thrombocytopenia, raised urea and creatinine levels, and raised LDH levels. A diagnosis of tacrolimus induced hemolytic uremic syndrome (HUS) with posterior reversible encephalopathy syndrome (PRES) was made. Ocular examination revealed a reddish-brown petaloid retinal lesion, which was better appreciated on red-free imaging as dark grey area pointing towards the fovea. OCT-A and SD-OCT revealed flow voids in deep retinal plexus, and disruption of ellipsoid and interdigitation zone, respectively, findings consistent with AMN. To the best of our knowledge, it is the first report of association of tacrolimus with AMN.

摘要

该报告强调了使用他克莫司与急性黄斑神经视网膜病变 (AMN) 的关联。一名 27 岁的女性，已知患有弥漫性增生性膜性肾小球肾炎，在开始服用他克莫司 3 个月后出现身体运动异常、意识丧失和左眼视力模糊。血液检查显示贫血、血小板减少、尿素和肌酐水平升高以及 LDH 水平升高。诊断为他克莫司诱发的溶血性尿毒症综合征（HUS）伴后部可逆性脑病综合征（PRES）。眼科检查显示红棕色花瓣状视网膜病变，在无红色成像中更容易被识别为指向中央凹的深灰色区域。OCT-A 和 SD-OCT 显示深部视网膜丛中的流动空隙，以及椭圆体和叉指区的破坏，分别与 AMN 的研究结果一致。据我们所知，这是他克莫司与 AMN 关联的第一份报告。