Disclosures: Megan A. Ziske, MD: No financial relationships or conflicts of interest

Case Description: Patient had decreased strength of bilateral lower extremities (4/5) with absent reflexes and decreased light touch sensation below left knee and below mid-calf on right. After her liver transplant, she suffered acute rejection, treated successfully with antilymphocytic antibody. She had since been on tacrolimus and mycophenolate for continued immunosuppression over the last 6 months. She reported a self-limited diarrheal illness 1 month prior to the initiation of her symptoms. During hospitalization, her weakness worsened to 2/5 strength in bilateral lower extremities as well as hands and wrists.

Setting: Tertiary care hospital

Patient: 23 year old female with past medical history of maple syrup urine disease status post deceased donor liver transplant in June 2019 presented with 5-day history of abnormal gait pattern and progressive ascending weakness and numbness of bilateral lower extremities and hands. Assessment/

Results: Full neurological workup was performed including lumbar puncture which showed no evidence of albuminocytologic dissociation. Electromyography showed evidence of muscle membrane irritability/denervation. Sensory nerve conduction studies were unobtainable in bilateral lower extremities and showed decreased amplitude in the left ulnar nerve; motor nerve conduction studies showed decreased amplitude in all nerves tested with normal distal latencies and decreased/borderline low conduction velocities. F waves were mildly prolonged in left ulnar and right tibial nerves. With these findings, she was diagnosed with acute motor sensory axonal neuropathy. She received IVIG for a total of 5 sessions with minimal improvement in strength or sensation. She was admitted to inpatient rehabilitation where strength continued to improve slowly.

Discussion: The pathophysiology of tacrolimus-induced Guillain-Barré syndrome is not known, but theories including the drug causing a dysimmune neuropathy or an inflammatory neuropathy via T cells mechanisms.

Conclusion: Rare cases have been reported of Guillain-Barré syndrome in the setting of solid-organ transplantation, including liver, who are on tacrolimus for immunosuppression, however, no cases of AMSAN have been reported.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-motor-sensory-axonal-neuropathy-in-a-patient-on-tacrolimus-for-recent-liver-transplantation/