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14 April 2018 : Case report  Thailand

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

Unusual clinical course

Suwasin Udomkarnjananun1ABEF, Natavudh Townamchai1ABE*, Mathurot Virojanawat1B, Yingyos Avihingsanon1E, Kearkiat Praditpornsilpa1E

DOI: 10.12659/AJCR.908886

Am J Case Rep 2018; 19:442-446


BACKGROUND: 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.

Keywords: Back Pain, Calcineurin, Kidney Transplantation

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923