Posterior Reversible Leukoencephalopathy Syndrome and Disseminated Varicella-Zoster Virus Infection After Kidney Transplantation

Introduction

Posterior reversible leukoencephalopathy syndrome (PRES) is a rare but serious complication in kidney transplant recipients, often triggered by calcineurin inhibitors (CNIs) and infections.

Case Presentation

A 52-year-old woman with end-stage kidney disease underwent cadaveric renal transplantation. Two months post-transplant, she presented with headaches, visual disturbances, hypertension, and altered consciousness. Cranial MRI confirmed PRES. After conversion from tacrolimus to cyclosporine and antihypertensive therapy, symptoms improved. However, the patient developed disseminated varicella-zoster virus infection, resulting in meningitis. Treatment with acyclovir and reduction of immunosuppression led to full recovery without recurrence.

Conclusion

This case highlights the importance of recognizing PRES and its triggers, including infections and CNIs, in kidney transplant recipients. Early diagnosis and appropriate management are crucial for preventing severe outcomes.