Polymyalgia rheumatica in a renal transplant patient.
A 56-year-old African American woman who was on triple immunosuppressive therapy (which includes tacrolimus, mycophenolate mofetil, and prednisone) for a renal transplant that she had received 10 years ago presented with malaise, low-grade fevers and severe bilateral pain in her shoulder, neck and thigh muscles. There was serological evidence of an acute inflammatory syndrome, including a very high erythrocyte sedimentation rate (ESR) and high interleukin-6 and C-reactive protein levels. An extensive workup for infection and malignancy was negative, and a muscle biopsy was normal. Under a working diagnosis of polymyalgia rheumatica (PMR) her prednisone dose was increased, leading to a complete remission.; her symptoms resolved and the ESR normalized. The occurrence of PMR in an immunosuppressed patient is unusual, but should be considered in the differential diagnosis in the appropriate clinical setting.
Banerjee
Satyaki
S
Brosnahan
Godela
G
D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage
D005938:Glucocorticoids; D011241:Prednisone