NEW-ONSET SEIZURES IN RE-DO LUNG TRANSPLANT RECIPIENT: CAN WE ALWAYS BLAME IT ON MEDICATIONS?

SESSION TITLE: Transplantation Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Lung transplant (LT) recipients incur a significant risk of seizures. Infectious and neurologic complications are common after transplant, and many necessary pharmacologic agents carry considerable risk of neurotoxicity. We present the case of an LT recipient with unclear etiology for new-onset seizures. Should medications be to blame? CASE PRESENTATION: The patient is a 25-year-old man with a highly complex transplant course but no previous history of neurologic disease. His index LT surgery for pulmonary veno-occlusive disease was performed at Duke University in 2016. His posttransplant course was complicated by posttransplant lymphoproliferative disorder, for which he received six cycles of chemotherapy with remission, and bronchiolitis obliterans syndrome. He underwent redo-LT at our center in 2020. He presented to our clinic in June 2022 with complaints of a syncopal episode causing him to fall from the edge of his bed, which he attributed to dehydration. Labs and head imaging were unrevealing for acute abnormalities; tacrolimus levels were therapeutic. In July, he complained of having syncope while driving, resulting in a single-car motor vehicle accident. At that time, he endorsed a prodrome of dizziness, nausea, and fatigue before the accident. Given the recurrent symptoms, an EEG was obtained which showed a 4-minute focal seizure arising from the right cerebral hemisphere with unclear clinical correlate. On chart review, he had endorsed intermittent dysosmia for the last 6 months, which was attributed to COVID-19 infection at the beginning of the year. Additionally, a head MRI from 2018 showed a known, unchanged suprasellar/prepontine cistern arachnoid cyst with supratentorial hydrocephalus. The patient had two additional seizure episodes captured with continuous EEG before complete resolution after initiating levetiracetam. DISCUSSION: New-onset seizures after LT are not uncommon. Focal seizures with unclear impairment in awareness in this patient were likely related to structural changes in the hippocampal region serving as a nidus for epileptiform discharges. CONCLUSIONS: Although this patient had a highly complicated transplant course, structural changes remain the most likely cause of seizures in this population. REFERENCE #1: Doratan M,Bodroghy R, et al. Seizure Incidence in Lung Transplant Patients. Neurolog. May 2022, 98 (18 Supplement) 3334. REFERENCE #2: Vaughan BV, et al. Seizure in lung transplant Recipients. Epilepsia. 1996 Dec;37(12):1175-9. DISCLOSURES: No relevant relationships by Ashwini Arjuna No relevant relationships by Bhuvin Buddhdev No relevant relationships by Hesham Mohamed No disclosure on file for Michael Olson