Central Nervous System (C NS) Lesions in Liver Transplant Recipients: Presumptive Diagnosis Based on Timing and Clinical Presentation.



CNS lesions developed in 8% of consecutive liver transplant recipients. Non -infectiouslesions occurred more frequently than infectious lesions: hemorrhages and/or infarcts (20%), central Pontine myelinolysis (I1%), anoxic-ischemic changes (22%), malignancy (2%), and cyclosporine induced lesions (1%). Anoxic, hemorrhagic, and infarcted lesions occurred a mean of 10, 18, and 3 days post-op, respectively. Defects in coagulation predisposed to hemorrhagic lesions. Notably, infarcts were not embolic in origin and formed in-situ. Infectious lesions occurred later in the post-transplant period. Aspergillus a plus was the most common (7%) occurring 2-6 weeks postop; lesions were multiple and all patients had concomitant pulmonary involvement. Candida CNS lesions occurred infrequently (1%), but was in the setting of disseminated candidiasis, often with candidemia. CMV and HSV occurred in 3%. CMV encephalitis was in the setting of disseminated CMV. CT scan was not distinctive, but CSF pleocytosis was typical for C MV. Bacterial CNS lesions were rare (

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ICAAC 33rd, 1993
    • ICAAC 33rd