title: Tacrolimus pain syndrome in renal transplant patients: report of two cases.
abstract: We report two renal transplant patients who experienced onset of severe bilateral knee pain 1 and 3 months after transplantation, respectively, while on tacrolimus therapy. Tacrolimus, like cyclosporine A, is an immunosuppressive agent that inactivates the enzyme calcineurin phosphatase. A bone pain syndrome was reported in 1989 in organ transplant recipients treated with cyclosporine A. Our cases suggest that tacrolimus may induce the same syndrome. Technetium 99m bone scanning shows increased uptake in the affected areas, and magnetic resonance imaging changes are consistent with bone marrow edema. The tacrolimus dosage need not be reduced unless trough levels are too high. The symptoms resolve completely within a few months. Imaging studies should be done to rule out avascular necrosis. The pathophysiology of this syndrome is discussed. Since tacrolimus was introduced recently, similar cases should be published.
authors.affiliation: Nephrology Service, Pasteur Hospital, 30, avenue de la Voie-Romaine, 06202 Nice cedex 1, France. nephrologie@chu-nice.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Franco
authors.forename: Aude
authors.initials: A
authors.lastname: Blaimont
authors.forename: Laetitia
authors.initials: L
authors.lastname: Albano
authors.forename: Christophe
authors.initials: C
authors.lastname: Bendini
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cassuto
authors.forename: Philippe
authors.initials: P
authors.lastname: Jaeger
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D007717:Knee / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced* / Q000503:physiopathology; D010147:Pain Measurement; D011877:Radionuclide Imaging; D018570:Risk Assessment; D013577:Syndrome; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D013667:Technetium
chemical_list: D013667:Technetium; D016559:Tacrolimus