# Posterior Reversible Leukoencephalopathy Syndrome and Disseminated Varicella‐Zoster Virus Infection After Kidney Transplantation

## TL;DR

A kidney transplant recipient developed PRES and a varicella-zoster virus infection, highlighting the need for early diagnosis and management in transplant patients.

## Contribution

This case report adds to the understanding of PRES triggers and complications in kidney transplant recipients.

## Key findings

- PRES was diagnosed in a kidney transplant recipient and improved after changing immunosuppressants and treating hypertension.
- The patient later developed disseminated varicella-zoster virus infection, which was successfully treated with acyclovir and reduced immunosuppression.
- The case emphasizes the importance of monitoring for PRES and its complications in transplant patients.

## Abstract

Posterior reversible leukoencephalopathy syndrome (PRES) is a rare but serious complication in kidney transplant recipients, often triggered by calcineurin inhibitors (CNIs) and infections.

A 52‐year‐old woman with end‐stage kidney disease underwent cadaveric renal transplantation. Two months post‐transplant, she presented with headaches, visual disturbances, hypertension, and altered consciousness. Cranial MRI confirmed PRES. After conversion from tacrolimus to cyclosporine and antihypertensive therapy, symptoms improved. However, the patient developed disseminated varicella‐zoster virus infection, resulting in meningitis. Treatment with acyclovir and reduction of immunosuppression led to full recovery without recurrence.

This case highlights the importance of recognizing PRES and its triggers, including infections and CNIs, in kidney transplant recipients. Early diagnosis and appropriate management are crucial for preventing severe outcomes.