Posterior reversible encephalopathy syndrome after liver transplantation in children: A rare complication related to calcineurin inhibitor effects

PRES is a neuroclinical and radiological syndrome that results from treatment with calcineurin inhibitor immunosuppressives. Severe hypertension is commonly present, but some patients may be normotensive. We report herein two children who received liver transplants, as treatment for biliary atresia in the first case and for Alagille`s syndrome in the second one. In the early postoperative, both patients presented hypertension and seizures. In both cases, the image findings suggested the diagnosis of PRES. The CT scan showed alterations in the posterior area of the brain, and brain MRI demonstrated parietal and occipital areas of high signal intensity. Both children were treated by switching the immunosuppressive regimen and controlling arterial blood pressure. They displayed full recuperation without any neurologic sequelae. Probably, the pathophysiology of PRES results from sparse sympathetic innervation of the vertebrobasilar circulation, which is responsible for supplying blood to the posterior areas of the brain. In conclusion, all liver-transplanted children who present with neurological symptoms PRES should be considered in the differential diagnosis, although this is a rare complication. As treatment, we recommend rigorous control of arterial blood pressure and switching the immunosuppressive regimen.

An old taxonomic dilemma: the identity of the western south Atlantic lebranche mullet (Teleostei: Perciformes: Mugilidae)

The identification of the lebranche mullet in the western south Atlantic has long been problematical. In most recent works either Mugil liza Valenciennes and M. platanus Gunther, 1880 or M. liza and M. cephalus Linnaeus, 1758 were recognized from the region and more rarely the occurrence of only one species has been proposed but without sufficient morphological, biochemical or molecular data to allow the designation of the taxonomically appropriate name. Analysis of meristic and morphometric data taken from samples collected from Venezuela to Argentina, clearly indicates that there is only one species of lebranche mullet in the Caribbean Sea region and the Atlantic coast of South America and that Mugil liza is the appropriate name. The comparison of the combined data from all the samples of M. liza with the data taken from one sample of M. cephalus that originated in the Mediterranean, the possible locality from which type specimens were collected (Eschmeyer and Fricke, 2009), revealed significant differences indicating that they are different species. It is also suggested that individuals from the western north Atlantic identified as M. cephalus might represent a population of M. liza in this region.