[Neurological symptoms in patient with focal segmental glomerulosclerosis treated with cyclosporin A--case report].

Unlabelled: Cyclosporin A using in treatment glomerulonephritis can cause neurological side effects.

Case Report: Nephrotic syndrome (NS) with microscopic hematuria was recognized in a boy in the age of 9.7 years. In kidney biopsy focal and segmental glomerulosclerosis was found. Remission was obtained on oral prednisone (60 mg/24 hrs). Second relapse of NS was treated with methylprednisolone pulse (VI pulses--600 mg/pulse) with a good effect. Third relapse of NS (secondary steroidoresistency) was treated with oral cyclophosphamide in a total dose 140 mg/kg/therapy--the treatment was complicated by a massive oral cavity mycosis and sinusitis. 3 weeks after starting cyclosporine A (CsA) proteinuria subsided. During CsA treatment severe headaches and pains in orbits with nausea appeared. In neurological examinations no abnormalities were found, in ophthalmological examination--slight opacification of the lens was found. EEG revealed lesions localised in a posterior cerebral parts, and CT of the head showed slight dilatation of ventricles. In MRI foci of signal intensification were found in subcortical white substance. CsA was stopped after 4 months of the treatment and prednisone was stopped a month later. Control MRI after 6 months revealed maintenance of the foci in white substance. The patient is under nephrological care, has no proteinuria and no neurological symptoms.

Conclusion: In patients treated with CsA appearance of headaches may suggest medication neurotoxicity.