title: Switching from tacrolimus to sirolimus halts the appearance of new sebaceous neoplasms in Muir-Torre syndrome.
abstract: Little is known about the effects of immunosuppression on patients with hereditary nonpolyposis colorectal cancer (HNPCC). We describe a kidney transplant recipient with unrecognized Muir-Torre syndrome in whom the administration of a tacrolimus-based regimen led to the eruption of multiple sebaceous tumors. The patient was later found to harbor an MSH2 mutation. Switching to a sirolimus-based regimen resulted in arrest of the disease. When the patient was switched back to tacrolimus, new facial lesions rapidly appeared. Switching again to sirolimus resulted again in halting the appearance of new lesions. This finding is in line with the known antiangiogenic activity of sirolimus and reports on the regression of cutaneous Kaposi's sarcoma in kidney transplant recipients switched from another immunosuppressive regimen to sirolimus. Further studies on the potential use of sirolimus for the treatment of de novo tumors in immunosuppressed kidney transplant recipients with HNPCC are warranted.
authors.affiliation: Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. zoharl@clalit.org.il
authors.forename: Z
authors.initials: Z
authors.lastname: Levi
authors.forename: R
authors.initials: R
authors.lastname: Hazazi
authors.forename: I
authors.initials: I
authors.lastname: Kedar-Barnes
authors.forename: E
authors.initials: E
authors.lastname: Hodak
authors.forename: E
authors.initials: E
authors.lastname: Gal
authors.forename: E
authors.initials: E
authors.lastname: Mor
authors.forename: Y
authors.initials: Y
authors.lastname: Niv
authors.forename: J
authors.initials: J
authors.lastname: Winkler
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000517:prevention & control*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000473:pathology*; D018450:Disease Progression; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology; D008297:Male; D008875:Middle Aged; D051718:MutS Homolog 2 Protein / Q000235:genetics; D009154:Mutation / Q000235:genetics; D012626:Sebaceous Gland Neoplasms / Q000473:pathology / Q000517:prevention & control*; D020123:Sirolimus / Q000627:therapeutic use*; D013577:Syndrome; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; C497172:MSH2 protein, human; D051718:MutS Homolog 2 Protein; D020123:Sirolimus; D016559:Tacrolimus