{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T14:48:44Z","timestamp":1784126924693,"version":"3.55.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:00:00Z","timestamp":1636934400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:00:00Z","timestamp":1636934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Tacrolimus is a macrolide immunosuppressant widely used to prevent rejection after solid organ transplantation. In general, adverse events of tacrolimus occur more often as the concentration of tacrolimus in the blood increases. We report the case of a 39-year-old man who developed a variety of adverse events despite in the therapeutic level of tacrolimus in the blood.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 39-year-old man underwent liver transplantation for liver cirrhosis due to alcoholic liver disease. The postoperative immunosuppressant consisted of tacrolimus (5\u2009mg) and mycophenolate (500\u2009mg) twice daily. Five months after taking tacrolimus, he presented with talkativeness, which gradually worsened. Brain magnetic resonance imaging performed 10\u2009months after tacrolimus administration revealed a hyperintense lesion affecting the middle of the pontine tegmentum on T2WI. The blood concentration of tacrolimus was 7.2\u2009ng\/mL (therapeutic range 5\u201320\u2009ng\/mL). After 21\u2009months, he exhibited postural tremor in both the hands. Twenty-four months after taking tacrolimus, he showed drowsy mentality, intention tremor, and dysdiadochokinesia. Electroencephalography presented generalized high-voltage rhythmic delta waves; therefore, tacrolimus was discontinued in suspicion of tacrolimus-induced neurotoxicity, and anticonvulsive treatment was started. The level of consciousness gradually improved, and the patient was able to walk independently with mild ataxia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This case shows that tacrolimus-induced neurotoxicity can occur even at normal concentrations. Therefore, if a patient taking tacrolimus exhibits psychiatric or neurologic symptoms, neurotoxicity should be considered even when the blood tacrolimus is within the therapeutic range.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-021-02479-z","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T08:03:54Z","timestamp":1636963434000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Tacrolimus-induced neurotoxicity from bipolar disorder to status epilepticus under the therapeutic serum level: a case report"],"prefix":"10.1186","volume":"21","author":[{"given":"Bora","family":"Jin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ga Yeon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5905-2188","authenticated-orcid":false,"given":"Sang-Myung","family":"Cheon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"key":"2479_CR1","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1111\/j.1432-2277.2000.tb01004.x","volume":"13","author":"WO Bechstein","year":"2000","unstructured":"Bechstein WO. Neurotoxicity of calcineurin inhibitors: impact and clinical management. Transpl Int. 2000;13:313\u201326. https:\/\/doi.org\/10.1111\/j.1432-2277.2000.tb01004.x.","journal-title":"Transpl Int"},{"key":"2479_CR2","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1136\/jnnp.2007.121806","volume":"78","author":"MR Junna","year":"2007","unstructured":"Junna MR, Rabinstein AA. Tacrolimus induced leukoencephalopathy presenting with status epilepticus and prolonged coma. J Neurol Neurosurg Psychiatry. 2007;78:1410\u20131. https:\/\/doi.org\/10.1136\/jnnp.2007.121806.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2479_CR3","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/1471-2369-7-7","volume":"7","author":"M Chegounchi","year":"2006","unstructured":"Chegounchi M, Hanna MG, Neild GH. Progressive neurological disease induced by tacrolimus in a renal transplant recipient: case presentation. BMC Nephrol. 2006;7:7. https:\/\/doi.org\/10.1186\/1471-2369-7-7.","journal-title":"BMC Nephrol"},{"key":"2479_CR4","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/S0022-510X(96)00231-6","volume":"145","author":"P Trouillas","year":"1997","unstructured":"Trouillas P, Takayanagi T, Hallett M, et al. International cooperative ataxia rating scale for pharmacological assessment of the cerebellar syndrome. The Ataxia neuropharmacology Committee of the World Federation of neurology. J Neurol Sci. 1997;145:205\u201311. https:\/\/doi.org\/10.1016\/S0022-510X(96)00231-6.","journal-title":"J Neurol Sci"},{"key":"2479_CR5","doi-asserted-by":"publisher","unstructured":"Wu G, Weng FL, Balaraman V. Tacrolimus-induced encephalopathy and polyneuropathy in a renal transplant recipient. BMJ Case Reports. 2013;2013. https:\/\/doi.org\/10.1136\/bcr-2013-201099.","DOI":"10.1136\/bcr-2013-201099"},{"key":"2479_CR6","doi-asserted-by":"publisher","first-page":"3175","DOI":"10.1136\/bcr-2013-201099","volume":"23","author":"BH Eidelman","year":"1991","unstructured":"Eidelman BH, Abu-Elmagd K, Wilson J, et al. Neurologic complications of FK 506. Transplant Proc. 1991;23:3175\u20138. https:\/\/doi.org\/10.1136\/bcr-2013-201099.","journal-title":"Transplant Proc"},{"key":"2479_CR7","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1248\/bpb.23.1008","volume":"23","author":"Y Sakamoto","year":"2000","unstructured":"Sakamoto Y, Makuuchi-M M, Harihara Y, Imamura H, Sato H. Correlation between neurotoxic events and intracerebral concentration of tacrolimus in rats. Biol Pharm Bull. 2000;23:1008\u201310. https:\/\/doi.org\/10.1248\/bpb.23.1008.","journal-title":"Biol Pharm Bull"},{"key":"2479_CR8","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/FTD.0000000000000640","volume":"41","author":"M Brunet","year":"2019","unstructured":"Brunet M, van Gelder T, \u00c5sberg A, et al. Therapeutic drug monitoring of tacrolimus-personalized therapy: second consensus report. Ther Drug Monit. 2019;41:261\u2013307.","journal-title":"Ther Drug Monit"},{"key":"2479_CR9","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12991-019-0242-6","volume":"18","author":"EH Seo","year":"2019","unstructured":"Seo EH, Kim SG, Cho YS, Yoon HJ. Tuberculum sellae meningioma with possible tacrolimus neurotoxicity manifesting as manic-like psychosis after kidney transplantation. Ann General Psychiatry. 2019;18:18. https:\/\/doi.org\/10.1186\/s12991-019-0242-6.","journal-title":"Ann General Psychiatry"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02479-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-021-02479-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02479-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T08:06:21Z","timestamp":1636963581000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-021-02479-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,15]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2479"],"URL":"https:\/\/doi.org\/10.1186\/s12883-021-02479-z","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,15]]},"assertion":[{"value":"9 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there are no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"448"}}