Atypical Posterior Reversible Encephalopathy Syndrome Imaging on Liver Transplant Patients

The Posterior Reversible Encephalopathy Syndrome (PRES) is a known clinical entity that presents as changes on neurological images (CT/MRI) with concomitant appearance of new onset neurological signs and symptoms. It complicates a diversity of diseases and the use of certain medication, mostly immunosuppressive, that should be taken into account when new clinical manifestations with neuroimaging changes appear on a immunosuppressed patient. Case report: We report a case of a Liver Transplant recipient patient with Tacrolimus as main immunosuppression, that develops new onset neurological focalization signs and diffuse atypical changes on imaging (CT and MRI/MRA) not according to her signs and symptoms, which improve once the calcineurin inhibitors are remove from her medication scheme. Conclusion: In any patient receiving calcineurin inhibitors the presence new onset changes on imaging and neurological manifestations, even if they are not the typical ones, imposes the ruling out of common infectious causes and the rotation of the immunosuppressive medication in expectance of improvement of the clinical picture, which support the diagnoses of PRES.