Immunosuppression-induced leukoencephalopathy from tacrolimus (FK506)

Ann Neurol. 1996 Oct;40(4):575-80. doi: 10.1002/ana.410400406.


Tacrolimus (FK506) has recently been approved for immunosuppression in organ transplantation, although its use is accompanied by a wide spectrum of neurotoxic side effects. We describe the clinical, radiological, and pathological features of 3 cases of tacrolimus-related leukoencephalopathy. The syndrome of immunosuppression-related leukoencephalopathy is proposed as an uncommon neurological syndrome occurring in patients with organ transplants involving demyelination, in particular in the parieto-occipital region and centrum semiovale. Although the syndrome is not associated with a particular (absolute) serum level of tacrolimus, it resolves spontaneously upon decreasing the dose. The tacrolimus-related syndrome has a similar radiographic and pathologic appearance as the analogous syndrome that occurs in patients taking cyclosporine.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Blindness / physiopathology
  • Dose-Response Relationship, Drug
  • Female
  • Graft Rejection / drug therapy
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Leukoencephalopathy, Progressive Multifocal / etiology*
  • Leukoencephalopathy, Progressive Multifocal / physiopathology
  • Liver Transplantation
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Occipital Lobe / physiopathology
  • Parietal Lobe / physiopathology
  • Remission, Spontaneous
  • Tacrolimus / administration & dosage
  • Tacrolimus / adverse effects*
  • Tacrolimus / therapeutic use
  • Tomography, X-Ray Computed


  • Immunosuppressive Agents
  • Tacrolimus