Reflex sympathetic dystrophy syndrome of the lower limbs in a renal transplant patient treated with tacrolimus.
BACKGROUND
Recently, a previously unrecognized posttransplant syndrome known as reflex sympathetic dystrophy syndrome of the lower limbs has emerged in patients receiving cyclosporine as immunosuppression. We describe herein this complication observed in a patient treated with tacrolimus after kidney transplantation.


METHODS
A 49-year-old man received a kidney transplant from a cadaver donor and was treated with tacrolimus. Three months later, the patient complained of severe pain in the lower limbs that affected both knees and ankles. Bone scintigraphy and magnetic resonance were consistent with reflex sympathetic dystrophy syndrome.


RESULTS
Laboratory tests that included creatinine, glomerular filtration rate, calcium, phosphate, urate, alkaline phosphatase, and parathormone were normal or near normal. Tacrolimus levels were around 13 microg/ml. Clinical improvement appeared slowly and spontaneously during the following 3 months, without appreciable changes in the tacrolimus level.


CONCLUSIONS
In kidney transplant patients, tacrolimus could be a risk factor for the development of a reflex sympathetic dystrophy syndrome.
Puig I Marí
J M
JM
Nephrology Department, Hospital del Mar, Barcelona, Spain.
Martinez-Miralles
E
E
Perich
X
X
Lloveras
J
J
Mir
M
M
Iñigo
V
V
Barbosa
F
F
Orfila
A
A
Masramón
J
J
D016572:Cyclosporine / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007866:Leg; D008297:Male; D008875:Middle Aged; D012019:Reflex Sympathetic Dystrophy / Q000209:etiology*; D016559:Tacrolimus / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus