Progressive multifocal cerebral infarction in a young kidney transplant recipient due to thrombotic microangiopathy

Abstract

Background: Renal transplant recipients frequently experience neurological complications. Whereas ischemic stroke, cerebral haemorrhage or hypertensive encephalopathy often result from vascular alterations prior to transplantation, other cerebral diseases like CNS infections, primary brain tumors and drug induced neurotoxicity may develop as consequences of the required post-transplant immunosuppressive treatment.

Case presentation: Here we report on an unusual clinical course of a young kidney transplant recipient with a cluster of fulminant necrotic brain lesions within a period of two months due to thrombotic microangiopathy.

Conclusion: Cerebral ischemia in organ transplant recipients should prompt one to consider thrombotic microangiopathy.

Figure 1

Cranial MR Imaging of the cerebral lesions. (A) Initial cranial MRI demonstrating right-sided temporo-parietal and thalamic lesions of different age. (B) MR angiography depicting missing flow signal of the right middle cerebral artery.

Figure 2

A cranial CT-scan at a later stage of disease demonstrated additional bilateral infarct lesions in the posterior circulation territory.

Figure 3

Postmortem diagnosis of thrombotic microangiopathy. Intravascular thrombi are indicated by arrows. A: pre-glomerular arteriole of the transplanted kidney; B: arteriole in the brain tissue; and thombi in a smaller (C) and in a larger arterial (D) vessel of the lung. PAS staining (A, B), HE staining (C, D), magnification x400.