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Calcineurin Inhibitor-Induced Pain Syndrome in ABO-Incompatible Living Kidney Transplantation: A Case Report
1Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Transplantation Proceedings
|January 21, 2017
Summary
Calcineurin-inhibitor-induced pain syndrome (CIPS) is rare, especially before kidney transplant. Tacrolimus (TAC) was identified as the cause of CIPS symptoms in a patient receiving immunosuppressive therapy.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Calcineurin-inhibitor-induced pain syndrome (CIPS), previously termed reflex sympathetic dystrophy syndrome, is associated with calcineurin inhibitors.
- Literature primarily documents CIPS post-kidney and bone marrow transplantation.
- This case explores CIPS during induction immunosuppression prior to kidney transplantation, involving an anti-rheumatoid drug.
Observation:
- A 53-year-old woman with rheumatoid arthritis, managed with salazosulfapyridine, underwent ABO-incompatible living kidney transplantation.
- She received induction immunosuppression with tacrolimus (TAC) and mycophenolate mofetil (MMF), discontinuing salazosulfapyridine.
- Three days later, she developed fever, fatigue, and polyarthritis.
Findings:
- Symptom resolution occurred upon cessation of TAC/MMF and re-initiation of salazosulfapyridine.
- Re-challenge with the same immunosuppressive regimen precipitated symptoms.
- Further testing confirmed TAC as the causative agent for CIPS, while cyclosporine (CsA) with MMF did not elicit symptoms.
Implications:
- Tacrolimus (TAC) can induce pain syndrome even before kidney transplantation.
- Identifying the specific immunosuppressant causing CIPS is crucial for patient management.
- This case highlights the importance of considering drug-induced side effects in transplant protocols.
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