Acute sensory neuropathy associated with rabbit antithymocyte globulin

Area of Science:

• Nephrology
• Immunology
• Neurology

Background:

• Rabbit antithymocyte globulin (RATG) is a key immunosuppressant for renal transplant recipients, utilized for treating acute rejection and as induction therapy.
• Its efficacy in preventing graft rejection is well-established, but potential adverse effects require ongoing monitoring.

Observation:

• A patient receiving RATG for renal transplantation developed acute, painful sensory neuropathy within one hour of administration.
• The patient's neuropathy presented as a distinct clinical event, prompting a thorough investigation into potential causative factors.

Findings:

• No alternative causes for the neuropathy were identified after a comprehensive review of the patient's medications, environmental exposures, and comorbid conditions.
• The temporal association between RATG administration and symptom onset, coupled with symptom resolution upon drug cessation, strongly suggests RATG as the likely etiology.
• This case highlights a potential, albeit rare, neurological adverse event associated with RATG therapy.

Implications:

• Clinicians should be vigilant for neuropathic symptoms in patients treated with RATG, particularly those with renal transplants.
• Early recognition and discontinuation of RATG may be crucial for managing this adverse event and preventing long-term neurological sequelae.
• Further research into the mechanisms underlying RATG-induced neuropathy is warranted to improve patient safety and treatment protocols.