Tacrolimus induced Mania with Psychosis - A Case Report

We are reporting a case of tacrolimus (Prograf) induced mania with psychotic features in a 68-year-old woman (Ms. A) with recent treatment for acute lymphoblastic leukemia (ALL). Neurotoxicity and delirium have been reported to occur with the macrolide immune suppressive tacrolimus in hepatic and renal allograph transplantations. In addition, nephrotoxicity and anxiety in renal transplants have been correlated with high trough tacrolimus blood concentrations (normal: 5-15 ng/ml, multi-enzymatic immunoassay). Our case is unique in that mania with psychotic features was noted even with subtherapeutic blood levels of tacrolimus (1.6 ng/ml), which did not respond to initial treatment with olanzapine.