Reversible cerebral vasoconstriction syndrome triggered by tacrolimus mimicked neuropsychiatric involvement in systemic lupus erythematosus

A 38-year-old woman, who was diagnosed with systemic lupus erythematosus (SLE) and treated with tacrolimus and prednisolone, developed severe headache suddenly. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed multiple constrictive lesions of right middle cerebral arteries and subarachnoid haemorrhage. The level of interleukin (IL)-6 in cerebrospinal fluid (CSF) was elevated to 301 pg/ml. Tacrolimus was discontinued, and then her symptoms started to improve on day 2. At day 6, MRI findings and IL-6 level in CSF also dramatically improved. Our case demonstrated that tacrolimus could trigger reversible cerebral vasoconstriction syndrome (RCVS) in SLE patients, even though the level of tacrolimus was kept in treatment level stably.