他克莫司致癫痫1例

One case of epilepsy induced by tacrolimus

1例4岁男性患儿,诊断为幼年型粒单核细胞白血病。因造血干细胞移植后出现腹泻,联合使用他克莫司注射液(1.25 mg,qd,ivgtt)、磷酸芦可替尼片(5 mg,qd)、甲泼尼龙片(8 mg,qd)治疗,予注射用伏立康唑(100 mg,q 12 h,ivgtt)预防真菌感染。在用药后第6天,患儿出现癫痫症状,血药浓度监测结果显示他克莫司浓度升高至128.8 ng·mL^(-1)。考虑癫痫症状可能是由于他克莫司过量所致的神经毒性引起,立即停药并给予甘露醇注射液等对症治疗后,他克莫司血药浓度降至3.96 ng·mL^(-1),之后患儿未再出现癫痫症状。

A 4-year-old male child was diagnosed as juvenile myelomonocytic leukemia.He developed diarrhea after hematopoietic stem cell transplantation,tacrolimus injection(1.25 mg,qd,ivgtt),ruxolitinib lucotinib phosphate tablets(5 mg,qd)and methylprednisolone tablets(8 mg,qd)were used in combination.And voriconazole injection(100 mg,q 12 h,ivgtt)for preventing fungal infection.On the 6th day of medication,he developed epileptic symptom.The result of therapeutic drug monitoring showed that the concentration of tacrolimus was as high as 128.8 ng·mL^(-1).It was considered that the appearance of epilepsy might be the neurotoxicity induced by the overdose of tacrolimus.After the withdrawal of tacrolimus and active treatment with mannitol injection,the concentration of tacrolimus dropped to 3.96 ng·mL^(-1).Epilepsy did not recur.