Delayed appearance of wing-beating tremor after liver transplantation in a patient with Wilson disease

Orthotopic liver transplantation (OLT) is the sole etiological treatment for Wilson disease (WD), but several neurological complications after OLT have been reported. We report a WD patient who developed a unilateral wing-beating tremor 6 years after OLT. New neurological symptoms develop immediately after OLT in most cases. In our patient, the onset of extrapyramidal symptoms was at a prolonged interval after OLT. To our knowledge this is the first patient with delayed extrapyramidal symptoms after OLT in WD where the pathophysiology of these late extrapyramidal symptoms is still unknown.