title: Calcineurin inhibitor-induced irreversible neuropathic pain after allogeneic hematopoietic stem cell transplantation.
abstract: 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.
authors.affiliation: Department of Hematology, Oncology and Respiratory Medicine, Okayama University Medical School, Okayama, Japan. nfujii@fhcrc.org
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Fujii
authors.forename: Kazuma
authors.initials: K
authors.lastname: Ikeda
authors.forename: Motoko
authors.initials: M
authors.lastname: Koyama
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Aoyama
authors.forename: Taro
authors.initials: T
authors.lastname: Masunari
authors.forename: Eisei
authors.initials: E
authors.lastname: Kondo
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsuzaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mizobuchi
authors.forename: Akio
authors.initials: A
authors.lastname: Hiraki
authors.forename: Takanori
authors.initials: T
authors.lastname: Teshima
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shinagawa
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Ishimaru
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
mesh_terms: 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
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus