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Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial...
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Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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Tacrolimus-induced plexopathy.

Caroline Kramarz1, David Game2, Sebastian Brandner3,4

  • 1Department of Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK c.kramarz@ucl.ac.uk.

Practical Neurology
|April 28, 2026
PubMed
Summary
This summary is machine-generated.

A rare case of tacrolimus-associated plexopathy in a transplant patient caused severe neuropathy. Switching immunosuppression to sirolimus resolved pain and improved function, highlighting the need for considering drug toxicity in progressive neuropathies.

Keywords:
NEUROPATHY

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Area of Science:

  • Neuroscience
  • Immunology
  • Nephrology

Background:

  • A 49-year-old woman with juvenile cystinosis, post-renal transplant, and on tacrolimus developed progressive, severe lumbosacral and brachial plexopathy.
  • The patient also had monoclonal gammopathy of undetermined significance and diabetes, complicating the diagnostic picture.

Purpose of the Study:

  • To investigate the cause of a progressive, debilitating neuropathy in an immunosuppressed transplant recipient.
  • To evaluate the potential role of tacrolimus in the development of plexopathy.

Main Methods:

  • Clinical case presentation with detailed neurological examination.
  • Extensive diagnostic workup including bone marrow biopsy and superficial peroneal and brachial plexus nerve biopsies.
  • Monitoring of neurological function and pain following a switch in immunosuppressive therapy from tacrolimus to sirolimus.

Main Results:

  • Initial investigations, including nerve biopsies, were non-diagnostic for the progressive neuropathy.
  • The patient experienced worsening neurological deficits and pain despite corticosteroid treatment.
  • Switching immunosuppression from tacrolimus to sirolimus led to complete pain resolution and significant functional improvement.

Conclusions:

  • Tacrolimus-associated plexopathy is a rare but critical consideration in transplant patients presenting with progressive neuropathy.
  • Prompt recognition and management, including drug-toxicity evaluation and potential medication change, can lead to favorable outcomes.