A 54-year-old male with a history of smoking, insulinized type 2 diabetes mellitus, liver transplantation for 8 years due to HCV+ chronic hepatitis with injected hepatocarcinoma and liver retransplantation due to recurrence of liver disease (20 mg/day) receiving cyclosporine.
During the second week after the OLT, the patient developed cerebellar dysarthria (tissue, ataxia and dysmetria), which progressively showed the presence of associated psychiatric disorders.
CT and MRI were requested, showing involutive cortical bone, small nonspecific demyelinating foci, and signal hyperintensity in the white matter that suggested cytotoxic edema.
The presence of hypomagnesemia was observed, with values of 1.68 mg/dl, and focal hypocholesterolemia of 107 mg/dl was observed in concomitant left-sided manifestation of non-clinical manifestation of rapid onset, which was not justified by the rest of EEG 25 minutes.
When two EEG seizures were observed in a short period of time, the presence of a non-convulsive partial status was considered.
Cyclosporine was discontinued due to clinical suspicion of toxicity despite the fact that levels were not within the toxic range (serum levels of 38 ng/ml), and treatment with tacrolimus and lamotrigine was initiated.
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The clinical course was torpid, adding episodes of disconnection of the medium; again showing in a second EEG 6 days after the first, critical epileptiform activity without concomitant clinical manifestation, associated with slowing of the basal activity.
These episodes increased in frequency, showing in the EEG control that was performed one week later, persistence of critical activity and increased slowing of the base activity, this time accompanied by supraversion of the gaze and oral movements.
Clinical worsening was admitted to the Intensive Care Unit, considering the picture caused by toxicity potentiated by hypomagnesemia.
All treatment was withdrawn, remaining only prednisone and adding mycophenolate as treatment with magnesium sulfate and phenytoin.
The evolution was favorable and she was discharged from the Intensive Care Unit.
The control EEG performed later showed disappearance of the ryptopeptiform activity and improvement of the background activity.
