is tacrolimus the sole culprit?
1 Department of Nephrology 2 Department of Internal MedicineMeir Hospital Sapir Medical Center Kfar-Saba Israel Email: zeevko{at}clalit.org.il’ + u + ‘@’ + d + ”//–> Case A 35-year-old female, 2 months post-transplant, was admitted because of a transient loss of consciousness. She had developed end-stage renal disease due to lupus nephritis and after 3 months of peritoneal dialysis received a living donor transplant from her mother. The graft functioned immediately post-operation, with serum creatinine stable at 0.8 mg/dl. Maintenance immunosuppressive regimen consisted of prednisone 15 mg o.d., mycophenolate mofetil (MMF) 500 mg b.i.d. and tacrolimus 4 mg b.i.d. Adjunctive prophylactic therapy included co-trimoxazole 500 o.d. and ganciclovir 1 g b.i.d. On admission, she was extremely agitated and disoriented with a marked coarse tremor and multiple myoclonic jerks involving all four limbs. Her body temperature was 37.5°C and supine blood pressure 110/70 mmHg. Generalized hyperreflex
