title: Acquired Pelger-Huët anomaly in association with concomitant tacrolimus and mycophenolate mofetil in a liver transplant patient: a case report and review of the literature.
abstract: Pelger-Huët anomaly is a congenital or acquired abnormality of neutrophil nuclear segmentation. The acquired form may be a result of a clonal myeloid malignancy, such as myelodysplastic syndrome, or may be a secondary nonclonal change related to a variety of underlying causes, including infections and medications. We report a case of a 56-year-old man who developed acquired Pelger-Huët anomaly following liver transplantation while on the immunosuppressive agents tacrolimus and mycophenolate mofetil. These medications have been reported in association with this abnormality, but usually as a single agent or in combination with other drugs. In our case, the Pelger-Huët anomaly may be the result of the combination of these 2 drugs or mycophenolate alone with subsequent desensitization because resolution of the abnormality occurred after a reduction in mycophenolate mofetil dose, and the abnormality did not recur when mycophenolate mofetil was increased to a dose previously associated with Pelger-Huët anomaly during the time that tacrolimus was discontinued.
authors.affiliation: Department of Laboratory Medicine, University of California, San Francisco, CA 94143-0100, USA.
authors.forename: Joan E
authors.initials: JE
authors.lastname: Etzell
authors.forename: Endi
authors.initials: E
authors.lastname: Wang
mesh_terms: D003888:Desensitization, Immunologic; D004359:Drug Therapy, Combination; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000276:immunology / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000276:immunology / Q000627:therapeutic use; D009504:Neutrophils / Q000187:drug effects / Q000473:pathology; D010381:Pelger-Huet Anomaly / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications; D020127:Recovery of Function; D016559:Tacrolimus / Q000276:immunology / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus