PMID- 37284436
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230608
IS  - 1179-142X (Print)
IS  - 1179-142X (Electronic)
IS  - 1179-142X (Linking)
VI  - 16
DP  - 2023
TI  - Sirolimus Induced Toxic Optic Neuropathy.
PG  - 329-332
LID - 10.2147/IMCRJ.S388481 [doi]
AB  - OBJECTIVE: To describe a case of optic neuropathy after prolonged sirolimus 
      therapy in the setting of cardiac transplant. BACKGROUND: Sirolimus is an 
      immunosuppressant that inhibits Mechanistic Target of Rapamycin (mTOR) and blocks 
      T-cell activation and B-cell differentiation by preventing response to 
      Interleukin-2 (IL-2). Tacrolimus is another immunosuppressive agent, one of the 
      known but uncommon side effects of which is bilateral optic neuropathy years 
      after taking the medication. To the best of our knowledge, this is the first 
      report of sequential optic neuropathy after years of treatment with sirolimus. 
      CASE PRESENTATION: A 69-year-old male with a history of cardiac transplantation 
      presented with progressive, sequential, and painless vision loss. Visual acuity 
      was 20/150 OD and 20/80 OS, with impaired color vision in both eyes (Ishihara 
      0/10) and bilateral disc pallor and mild optic disc edema in the left eye. Visual 
      field was constricted in both eyes. The patient was on prolonged sirolimus 
      therapy for over 7 years. Orbital MRI revealed bilateral chiasmatic thickness and 
      FLAIR hyperintensity, without optic nerve enhancement post gadolinium. After 
      extensive work up, other etiologies such as infectious, inflammatory, and 
      neoplastic lesions were ruled out. Subsequently, sirolimus was substituted with 
      cyclosporin that led to gradual improvement of vision and visual fields 
      bilaterally. CONCLUSION: Optic neuropathy is a rare side effect of tacrolimus, 
      which has been seen as sudden, painless, and bilateral vision loss in 
      post-transplant patients. Other concurrent medications influencing the cytochrome 
      P4503A enzyme complexes may alter the pharmacokinetics of tacrolimus and increase 
      the likelihood of toxicity. Discontinuation of offending agent has been shown to 
      improve visual defects. We presented a rare case of optic neuropathy in a patient 
      on sirolimus, whose visual defects improved upon discontinuation of sirolimus and 
      switching to cyclosporin.
CI  - (c) 2023 Pakravan et al.
FAU - Pakravan, Parastou
AU  - Pakravan P
AD  - Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami 
      Miller School of Medicine, Miami, FL, USA.
FAU - Miri, Shahnaz
AU  - Miri S
AD  - Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami 
      Miller School of Medicine, Miami, FL, USA.
FAU - Lam, Byron L
AU  - Lam BL
AD  - Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami 
      Miller School of Medicine, Miami, FL, USA.
LA  - eng
PT  - Case Reports
DEP - 20230531
PL  - New Zealand
TA  - Int Med Case Rep J
JT  - International medical case reports journal
JID - 101566269
PMC - PMC10239645
OTO - NOTNLM
OT  - immunosuppressant
OT  - optic neuropathy
OT  - sirolimus
OT  - vision loss
COIS- The authors report no conflicts of interest in this work.
EDAT- 2023/06/07 13:10
MHDA- 2023/06/07 13:11
PMCR- 2023/05/31
CRDT- 2023/06/07 09:48
PHST- 2022/09/23 00:00 [received]
PHST- 2023/05/25 00:00 [accepted]
PHST- 2023/06/07 13:11 [medline]
PHST- 2023/06/07 13:10 [pubmed]
PHST- 2023/06/07 09:48 [entrez]
PHST- 2023/05/31 00:00 [pmc-release]
AID - 388481 [pii]
AID - 10.2147/IMCRJ.S388481 [doi]
PST - epublish
SO  - Int Med Case Rep J. 2023 May 31;16:329-332. doi: 10.2147/IMCRJ.S388481. 
      eCollection 2023.