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- liver disease
- Parkinson's disease
- Alzheimer's disease
A 46-year-old woman with a history of kidney transplant for IgA nephropathy (on tacrolimus and mycophenolate mofetil), type II diabetes and non-alcoholic steatohepatitis was admitted for gait instability. Neurological examination revealed lower limb sensory ataxia and brisk patellar reflexes. Brain/spinal MRI results were normal. Blood tests disclosed macrocytosis (but no vitamin deficiencies) and mild hepatic cytolysis. Lumbar puncture showed the absence of cells, normal protein, hypoglycorrhachia (glycorrhachia: 0.62 g/l; glycaemia: 1.65 g/l) and no oligoclonal bands. Cerebrospinal fluid cultures were negative. Assays for neurotropic viruses, paraneoplastic …
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.