Calcineurin-inhibitor-induced pain syndrome after bone marrow transplantation
Tóm tắt
Calcineurin-inhibitor-induced pain syndrome (CIPS), a rare complication seen in patients with organ transplants, is associated with the use of calcineurin inhibitors (CIs) such as cyclosporine (CSP) and tacrolimus (FK). Patients with this syndrome usually present with severe leg pain. This case report demonstrates the successful pain control of this pain syndrome in a 42-year-old female patient who had been given CIs (FK and CSP) as an immunosuppressive agent after a bone marrow transplant. Twenty-one days after the transplantation, she complained of severe pain in her bilateral lower extremities; this lasted several weeks, and was resistant to ordinary analgesics such as intramuscular pentazocine, intravenous morphine, and even oral nifedipine, which is generally accepted as an effective analgesic agent for the pain in this syndrome. Due to the presence of allodynia, our patient’s pain had neuropathic pain-like characteristics, unlike the pain in previously reported patients with other organ transplants. Her pain was successfully relieved by the administration of oral amytriptyline, clonazepam, oxycodone, and intravenous lidocaine, all of which ordinarily have an analgesic effect on neuropathic pain. CIPS in patients with hematopoietic stem cell transplants treated with FK may have a mechanism by which neuropathic pain may develop that is different from that in patients with other organ transplants.
Tài liệu tham khảo
Bechstein WO (2000) Neurotoxicity of calcineurin inhibitors: impact and clinical management. Transplant Int 13:313–326
Lucas VP, Ponge TD, Plougastel-Lucas ML, Glemain P, Hourmant M, Soulillou JP (1991) Musculoskeletal pain in renal-transplant recipients. N Engl J Med 325:1449–1450
Sanches EN, Criado AS, Guajardo AS, Zarza LP, Mola EM, Banos (1994) Leg bone pain syndrome due to cyclosporine in a renal transplant patient. Clin Exp Rheumatol 12:653–656
Gauthier VJ, Barbosa LM (1994) Bone pain in transplant recipients responsive to calcium channel blockers. Ann Intern Med 121:863–865
Stevens JM, Hilson AJW, Sweny P (1995) Post-renal transplant distal limb bone pain. Transplantation 60:305–307
Goffin E, Vande Berg B, Pirson Y, Malghem J, Maldague B, Strihou CY (1993) Epiphyseal impaction as a cause of severe osteoarticular pain of lower limbs after renal transplantation. Kidney Int 44:98–106
Kida A, Ohashi K, Kobayashi T, Sakai M, Yamashita T, Akiyama H, Kishida S, Sakamaki H (2004) Incapacitating lower limb pain syndrome in cord blood stem cell transplant recipients with calcineurin inhibitor. Pathol Oncol Res 10:204–206
Villaverde V, Cantalejo M, Balsa A, Mola EM, Sanz A (1999) Leg bone pain syndrome in a kidney transplant patient treated with tacrolimus (FK506). Ann Rheum Dis 58:653–654
Grotz WH, Breitenfeldt MK, Braune SW, Allmann KH, Krause TM, Rump JA, Schollmeyer PJ (2001) Calcineurin-inhibitor induced pain syndrome (CIPS): a severe disabling complication after organ transplantation. Transplant Int 14:16–23
Stoltenburg-Didinger G, Boegner F (1992) Glia toxicity in dissociated cell cultures induced by cyclosporine. Neurotoxicology 13:179–184
McDonald JW, Goldberg MP, Gwag BJ, Chi SI, Choi DW (1996) Cyclosporine induces neuronal apoptosis and selective oligodendrocyte death in cortical cultures. Ann Neurol 40:750–758
Sander M, Lyson T, Thomas GD, Victor RG (1996) Sympathetic neural mechanism of cyclosporine-induced hypertension. Am J Hypertens 9:121S–138S