A Case of Tacrolimus-Induced Posterior Reversible Encephalopathy Syndrome Initially Presenting as a Bilateral Optic Neuropathy

PURPOSE: To report a case of asymmetric bilateral optic neuropathy in a patient receiving tacrolimus for immunosuppression after kidney transplantation with subsequent stroke-like symptoms of posterior reversible encephalopathy syndrome (PRES). METHOD: Case report. In a 54-year-old Hispanic male receiving tacrolimus after orthotropic kidney transplantation, serial ophthalmologic examinations, laboratory studies, and imaging were performed. RESULTS: The patient had deterioration of vision in the left eye with subclinical optic neuropathy in the right eye, with clinical features resembling ischemic optic neuropathy. Additionally, he developed a change in mental state with weakness of extremities. After the cessation of tacrolimus, the visual loss remained but the other neurologic symptoms resolved. CONCLUSION: Tacrolimus may be associated with optic neuropathy and PRES at the initial presentation to an ophthalmologist.