Tacrolimus leukoencephalopathy: A neuropathologic confirmation

Abstract
A 40-year-old woman with biopsy-proven acute rejection was admitted 3 weeks after an orthotopic liver transplant for alcoholic cirrhosis. Alanine aminotransferase was elevated at 226 IU/L (<50 IU/L). She also had elevated cholesterol levels (237–411 IU/L) and was hypertensive (approximately 160/90). Erythrocytes showed anisocytosis and poikilocytosis (spiculated, fragmented, and targets). Tacrolimus 4 mg BID had been started the day after transplantation.