Calcineurin inhibitor-induced irreversible neuropathic pain after allogeneic hematopoietic stem cell transplantation.
The calcineurin inhibitors (CIs) cyclosporine A and tacrolimus are essential for graft-versus-host disease prophylaxis but are associated with adverse effects, including neurotoxicity. We report a case of irreversible CI-induced neuropathic pain following allogeneic hematopoietic stem cell transplantation. The patient developed dysesthesia, electric shock-like pain, and severe itching followed by intractable analgesic-resistant pain in the lower extremities. There were no abnormal radiographic findings, and there was no improvement with a reduction of CI dosage or with administration of a calcium channel blocker. These clinical findings are similar to but inconsistent with CI-induced musculoskeletal pain syndromes previously reported in organ transplantation.
Fujii
Nobuharu
N
Department of Hematology, Oncology and Respiratory Medicine, Okayama University Medical School, Okayama, Japan. nfujii@fhcrc.org
Ikeda
Kazuma
K
Koyama
Motoko
M
Aoyama
Kazutoshi
K
Masunari
Taro
T
Kondo
Eisei
E
Matsuzaki
Takashi
T
Mizobuchi
Satoshi
S
Hiraki
Akio
A
Teshima
Takanori
T
Shinagawa
Katsuji
K
Ishimaru
Fumihiko
F
Tanimoto
Mitsune
M
D000328:Adult; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006086:Graft vs Host Disease / Q000000981:diagnostic imaging / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D010146:Pain / Q000139:chemically induced* / Q000000981:diagnostic imaging; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D011859:Radiography; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects*; D014184:Transplantation, Homologous
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus