S Cyclosporin
Inflammatory breast disease: case reportA 21-year-old woman, who had undergone a renal transplant, developed inflammatory breast disease during treatment with cyclosporin.The woman presented with a 6-week history of gradual painful enlargement of the breasts approximately 7 months after starting treatment with cyclosporin ['Neoral'] 75mg twice daily. Her maintenance trough cyclosporin concentrations had been between 80 and 120 µg/L. She was also taking atenolol, amlodipine and azathioprine.An examination revealed marked breast hypertrophy with the woman's right breast larger than her left. In addition, the skin on her breasts was warm, tense and erythematous. Blood tests showed an elevated corrected serum calcium level and a decreased phosphate level. Her parathyroid hormone level was undetectable and her alkaline phosphatase level was slightly elevated. Mammography showed very glandular and dense breasts and an ultrasound scan revealed diffuse inflammation. The results of a biopsy showed a marked increase in fibrous stroma and oedema.Cyclosporin was replaced with tacrolimus and a decrease in breast pain, erythema and engorgement was evident within 2 weeks. In addition, the woman's calcium and phosphate levels returned to normal. Approximately 3 months later, her breasts were not erythematous or engorged, but they remained uncomfortably enlarged. She was scheduled for breast reductive surgery.Eardley KS, et al. Transplant-associated inflammatory breast disease. Nephrology Dialysis