Hospitalized psychoses after liver transplantation

Abstract

Calcineurin inhibitors can cause neurological and psychiatric side effects. Mild symptoms to severe complications can be found.

Case presentation

We report a 49 year old man who received an orthotopic liver transplantation in May 2010. He received tacrolimus. Ten days later, while he was still in Hospital, he suffered behavioural disorders, being psychotic with delusions of persecution; he called the police thinking that he was being poisened by the staff of the Hospital. Although his Tacrolimus blood concentration had been kept in the normal range, his symptoms improved dramatically when the Tacrolimus was changed into Cyclosporine and Haloperidol was introduced at high doses (7 mg/day) for 10 days when the dose was reduced to 4 mg/day.

Medical history

Chronic hepatitis VHC 1a in 1994. Received treatment with Interferon alfa in 1997 with no antiviral answer. In 2001 new treatment with pegylated Interferon and Ribavirine with positive virological answer but had to be stopped because of psychoses secondary to treatment. New treatment in March 2006 to March 2007 with Pegasys+Ribavirine with rapid virologycal answer with prophylactic Olanzapine 5 mg during a year with no psychotic symptons. In May 2009, Child Pugh C10, in list for liver transplantation.

We discuss the implications of these findings and the relevance for future clinical care in these patients.