Convulsion during cyclosporin A therapy for nephrotic syndrome

Abstract

A 10-year-old boy with nephrotic syndrome developed convulsions 6 weeks after the start of cyclosporin A (CyA) therapy. Generalized tonic-clonic convulsion occurred during relapse of nephrotic syndrome after influenza A infection. T2-weighted magnetic resonance imaging (MRI) showed high signal intensities in bilateral parieto-occipital lobes. He recovered from the convulsions and the MRI findings returned to normal early without neurological sequelae. CyA was discontinued for 1 week and then restarted. He has had no further convulsions or recurrence of nephrotic syndrome since that time. He had no evidence of high blood level of CyA, hypertension, electrolyte abnormalities, or renal or hepatic dysfunction. He was diagnosed with CyA-related reversible posterior leukoencephalopathy syndrome based on the rapid recovery of clinical symptoms and the characteristic MRI finding. Influenza A infection may have damaged the blood-brain barrier, paving the way for central nervous system toxicity.