Hindawi Publishing Corporation Case Reports in Transplantation Volume 2013, Article ID 708961, 3 pages http://dx.doi.org/10.1155/2013/708961 Case Report Tacrolimus-Related Cerebral Microbleeds after Lung Transplantation L. Mechtouff, 1 F. Piegay, 2,3,4 J. Traclet, 4 F. Philit, 4 P. Boissonnat, 4 M. Hermier, 1,2,3,5,6 I. Durieu, 2,3,7 T.-H. Cho, 1,2,3,5,6 N. Nighoghossian, 1,2,3,5,6 and J.-F. Mornex 2,3,4,8 1 Hospices Civils de Lyon, Hˆ opital Pierre Wertheimer, 59 Boulevard Pinel, 69677 Bron, France 2 Universit´ e de Lyon, 69003 Lyon, France 3 Universit´ e Lyon 1, 69003 Lyon, France 4 Hospices Civils de Lyon, Hˆ opital Louis Pradel, 69677 Bron, France 5 CNRS UMR 5220, INSERM U1044, CREATIS, 69622 Villeurbanne, France 6 INSA de Lyon, 69622 Villeurbanne, France 7 Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 69495 Pierre B´ enite, France 8 INRA UMR 754, R´ etrovirus et Pathologie Compar´ ee, 69007 Lyon, France Correspondence should be addressed to L. Mechtouf; laura.mechtouf@chu-lyon.fr Received 6 September 2013; Accepted 26 September 2013 Academic Editors: D. Capone, R. Grenda, and H. P. Tan Copyright © 2013 L. Mechtouf et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Posterior reversible encephalopathy syndrome is a well-known complication of treatment by tacrolimus. We report 2 cases of lung transplant recipients treated with tacrolimus who developed cerebral microbleeds on T2 ∗ -weighted sequences in the acute setting of posterior reversible encephalopathy syndrome. Cerebral microbleeds may be a marker of tacrolimus-induced vasculopathy that may be detected earlier by neuropsychological and magnetic resonance imaging monitoring in transplant recipients treated with tacrolimus. 1. Introduction Posterior reversible encephalopathy syndrome (PRES), although rare (1.6%/year), is a well-recognized and severe cerebral complication of the treatment by tacrolimus [1]. Tacrolimus could exert a direct toxicity on the endothelial cells leading to the alteration of the blood-brain barrier and the release of potent vasoconstrictor resulting in vasospasm and hypoperfusion [2]. Cerebral microbleeds (CMBs) are unusual in the setting of PRES and have seldom been reported in tacrolimus-treated patients. We recently observed CMBs on MRI in two-lung- transplant recipients treated with tacrolimus in the acute setting of PRES. 2. Case 1 A 19-year-old cystic fbrosis patient with a history of dia- betes underwent double lung transplantation. He was started on tacrolimus (10 mg/d), prednisone, and mycophenolate mofetil. Four months later, he developed a visual seizure secondary generalised. On admission, blood pressure was 160/105 mmHg. Te tacrolimus blood trough level (CO) was 8.8 g/L, total cholesterol was 3.25 mmol/L, and crea- tinine was 71 mol/L. A computed tomography (CT) scan showed right parietal and bilateral occipital hypodensities without acute hemorrhage. Magnetic resonance imaging (MRI) showed right parietal and bilateral occipital hyper- intensities on fuid-attenuated-inversion-recovery (FLAIR) images with high apparent difusion coefcient (ADC) and multiple CMBs on T2 ∗ -weighted sequences in the cortico- subcortical junction of the two cerebral hemispheres and corpus callosum (Figure 1) without arterial abnormality. Cerebral spinal fuid (CSF) and electroencephalogram (EEG) were normal. Te dosage of tacrolimus was decreased and everolimus was initiated. Te patient did not experience further seizures. Control MRI performed one month later