Publication:

Tacrolimus-associated hemichorea in a post–renal transplant patient: a case report

Tacrolimus is a calcineurin inhibitor widely used as maintenance immunosuppression after renal transplantation. Although neurotoxicity is a well-recognized complication of tacrolimus therapy, manifesting as tremor, seizures, posterior reversible encephalopathy syndrome, and encephalopathy, the occurrence of choreiform movements—particularly hemichorea—is exceptionally rare. We report a 32-year-old male who developed acute-onset unilateral chorea one month after renal transplantation while receiving tacrolimus and prednisolone. Laboratory evaluation revealed a markedly elevated tacrolimus trough level, while magnetic resonance imaging (MRI) of the brain demonstrated an old right capsulo-ganglionic hemorrhage, providing a structural vulnerability. The patient improved promptly after reduction of tacrolimus dosing and symptomatic therapy. This case underscores the need to consider tacrolimus-induced neurotoxicity in the differential diagnosis of new-onset movement disorders in transplant recipients.