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. 2017 Jan 10;4(2):e319.
doi: 10.1212/NXI.0000000000000319. eCollection 2017 Mar.

Delayed Tacrolimus Leukoencephalopathy, a Rare and Reversible Cause of Dementia

Free PMC article

Delayed Tacrolimus Leukoencephalopathy, a Rare and Reversible Cause of Dementia

Diego Barragán-Martínez et al. Neurol Neuroimmunol Neuroinflamm. .
Free PMC article


Figure. Neuroimaging and pathologic findings
(A) Axial fluid-attenuated inversion recovery (FLAIR) and (B) enhanced T1-weighted MRI on admission show diffuse changes involving subcortical and deep white matter in both hemispheres and posterior fossa, with multiple subtle patchy areas of contrast enhancement. (C) MRI 6 weeks after discontinuing tacrolimus evidences resolution of contrast enhancement. Rests of hematoma at the biopsy site can also be seen. (D) Follow-up FLAIR MRI 18 months after tacrolimus withdrawal shows clear and partial leukoencephalopathy improvement. Brain biopsy specimens: (E) hematoxylin & eosin staining sections reveal a hypercellular and vacuolated white matter, with occasional perivascular inflammatory infiltrates (×40); (F) immunohistochemical staining confirms a T lymphocyte (CD3-positive) predominance (×40); (G) white matter astrogliosis with enlarged astrocytic cell bodies shows a high immunoreactivity for glial fibrillary acidic protein (×40). (H) A large number of CD68-positive macrophages is also observed (×4). (I) Luxol fast blue staining and (J) neurofilament immunochemistry sections show a myelin-axonal dissociation with relative preservation of axons, suggestive of demyelination (×4).

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