Pain Syndrome Induced by Calcineurin Inhibitor and Resolved by Conversion to Sirolimus in a Child After Kidney Transplantation: A Case Report

Prates, Liliane Cury; Rigatto, Sumara Zuanazi Pinto; Lutaif, A.C.B.; Oliveira, Lívia Costa de; Pereira, Lilian Elgalise Techio; Passerotti, Larissa Camargo; Belangero, Vera Maria Santoro

doi:10.1016/j.transproceed.2012.07.138

Cited by 6 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tacrolimus and cyclosporine concentration should be maintained in the normal range. There are some reports of pain cessation in response to switching CNI to mechanistic target of rapamycin (mTOR) inhibitor in patients with normal CNI concentrations [ 22 , 23 ]. A medication with evidence of successful treatment is the calcium channel blocker (CCB) nifedipine (or nitrendipine) [ 24 ].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

An Unusual Manifestation of Calcineurin Inhibitor-Induced Pain Syndrome in Kidney Transplantation: A Case Report and Literature Review

et al. 2018

View full text Add to dashboard Cite

Patient: Female, 23Final Diagnosis: Calcineurin inhibitor-induced pain syndromeSymptoms: Back painMedication: —Clinical Procedure: Supportive treatmentSpecialty: TransplantologyObjective:Unusual clinical courseBackground:Calcineurin inhibitors (CNI) are the mainstay immunosuppressive drugs for kidney transplantation. Although they provide excellent allograft and patient outcomes, adverse effects are frequently encountered. Calcineurin inhibitor-induced pain syndrome (CIPS) is a rare adverse effect of CNI. Previous case reports with CIPS diagnosis involved incapacitating pain in the lower extremities.Case Report:In this article, we report the first case of CIPS with severe back pain as the presenting symptom, which was correlated with a high tacrolimus trough concentration due to a drug interaction with clotrimazole troche. Magnetic resonance imaging (MRI) of the spine showed bone marrow edema, which is consistent with previous case reports. The patient’s symptoms resolved within 3 weeks of the onset of pain. Treatments were symptomatic care and lowering the tacrolimus trough concentration. Pain was improved significantly with pregabalin but not with nifedipine.Conclusions:We reviewed the literature of kidney transplant cohorts with CIPS to ascertain prevalence, pain characteristics, and treatment outcomes. Apart from our case, all patients experienced lower extremities pain and were pain-free during the follow-up period, without any residual abnormalities. CIPS is a benign but adverse effect of CNI. Counselling patients about the disease’s natural history and supportive care remain the best treatment.

show abstract

Section: Discussion and Literature Reviewmentioning

confidence: 99%

An Unusual Manifestation of Calcineurin Inhibitor-Induced Pain Syndrome in Kidney Transplantation: A Case Report and Literature Review

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Interestingly, it is associated with good long term prognosis of the graft. Treatment can be supportive for pain-management, removal of the CNI and replacement with non-CNI immunosuppression (46), or treatment with calcium channel blocking agents (47). There is one case report of rapid improvement in symptoms with one-time infusion of iloprost (48).…”

Section: Calcineurin Inhibitors (Cnis)mentioning

confidence: 99%

Neurologic complications of kidney transplantation

Shoskes

Wilson

2019

Transl. Androl. Urol

View full text Add to dashboard Cite

Renal transplant is the most common organ transplant in the United States, and the frequency of kidney transplants continues to rise as transplant offers improved survival and quality of life compared to dialysis. However, complications are not uncommon and patients frequently encounter issues requiring hospitalization, especially in the first year postoperatively. Complications that arise are typically related to surgical complications, immunosuppressive medications, or infection due to immunosuppression. Neurological complications are fairly common post-operatively, and are associated with increased morbidity and mortality in this population. This review discusses the most common etiologies of neurological complications after kidney transplant, including infection, malignancy, medication related, acute neuropathy, and other neurological pathology.

show abstract

“…The most seen sirolimus-based adverse effects are diarrhea, constipation, vomiting, nausea, abdominal pain, leg pain, acne, headache, and sleep problems. 2 Here, we present a patient who had abdominal pain, nausea, vomiting, and ventricular extrasystole attacks due to sirolimus toxicity, which improved after dose adjustment during follow-up after heart transplant. Pain syndrome associated with the use of calcineurin inhibitors improving with sirolimus has been previously reported; however, because we did not encounter pain syndrome associated with use of sirolimus in our patient, we chose to report our experience.…”

Section: Introductionmentioning

confidence: 98%

“…1 Recently, sirolimus has been used to decrease adverse effects of calcineurin inhibitors and for therapy of calcineurin inhibitor-related nephropathy and to treat rejection in 9% of the pediatric patients who undergo heart transplant. 2 Although its benefits on organ rejection and renal function have been shown in pediatric studies, there are limited data about use of sirolimus in pediatric heart transplant patients. Proper sirolimus dose levels and the associated adverse effects are not clearly known in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Karakaş

Erdoğan²,

Ozdemır³

et al. 2016

Exp Clin Transplant

View full text Add to dashboard Cite

For patients with late congenital heart diseases and advanced heart failure, heart transplant is the one of the most effective known treatment methods. With the development of immunosuppressive medicines, it is possible to prevent and treat rejection, and survival after organ transplant has increased rapidly. Calcineurin inhibitors (tacrolimus and cyclosporine), mycophenolate mofetil, and corticosteroids are used together in many centers as immunosuppressive medications. Although the use of calcineurin inhibitors is essential, therapy is switched to sirolimus in some specific cases and when significant adverse effects occur. The most seen sirolimus-based adverse effects are diarrhea, constipation, vomiting, nausea, abdominal pain, leg pain, acne, headache, and sleep problems. Here, we present a patient who had abdominal pain, nausea, vomiting, and ventricular extrasystole attacks due to sirolimus toxicity, which improved with dose adjustment during follow-up after heart transplant. Pain associated with the use of calcineurin inhibitors improving with sirolimus has been previously reported before; however, because we did not encounter pain syndrome associated with use of sirolimus, we chose to report our experience with this patient.

show abstract

Pain Syndrome Induced by Calcineurin Inhibitor and Resolved by Conversion to Sirolimus in a Child After Kidney Transplantation: A Case Report

Cited by 6 publications

References 11 publications

An Unusual Manifestation of Calcineurin Inhibitor-Induced Pain Syndrome in Kidney Transplantation: A Case Report and Literature Review

An Unusual Manifestation of Calcineurin Inhibitor-Induced Pain Syndrome in Kidney Transplantation: A Case Report and Literature Review

Neurologic complications of kidney transplantation

Untitled

Contact Info

Product

Resources

About