title: Rhabdomyolysis as a clinical manifestation of association with ciprofibrate, sirolimus, cyclosporine, and pegylated interferon-α in liver-transplanted patients: a case report and literature review.
abstract: BACKGROUND
  Rhabdomyolysis is a syndrome characterized by impaired metabolic integrity of myocytes, causing the release of intracellular constituents into the circulation, and can be a serious side effect of drug intake.
  
  
  METHODS
  This report describes a unique case of rabdomyolysis secondary in which ciprofibrate, sirolimus, cyclosporine, and pegylated interferon-α in a liver transplant patient was used. A 47-year-old male liver transplant recipient in 2009, who had hepatitis C and incidental hepatocellular carcinoma, underwent immunosuppressive therapy (cyclosporine and sirolimus). The patient is currently in treatment for viral recurrence with pegylated interferon-α and ribavirin; he had a history of hypertriglyceridemia treated with ciprofibrate. He had development of severe and generalized myalgia and fever after the eighth application of pegylated interferon-α and increasing doses of cyclosporine. Laboratorial tests showed acute renal failure and significant increase in creatine kinase. Rhabdomyolysis secondary to interaction of fibrate-cyclosporine-pegylated interferon-α was postulated.
  
  
  CONCLUSIONS
  Medical professionals should be aware of possible drug interactions and should monitor patients receiving these drugs.
authors.affiliation: Faculty of Medical Science, State University of Campinas, São Paulo, Brazil.
authors.forename: A G
authors.initials: AG
authors.lastname: dos Santos
authors.affiliation: Faculty of Medical Science, State University of Campinas, São Paulo, Brazil.
authors.forename: A C
authors.initials: AC
authors.lastname: Guardia
authors.affiliation: Faculty of Medical Science, State University of Campinas, São Paulo, Brazil.
authors.forename: T S
authors.initials: TS
authors.lastname: Pereira
authors.affiliation: Hospital de Clínicas, State University of Campinas, São Paulo, Brazil.
authors.forename: E C
authors.initials: EC
authors.lastname: Ataíde
authors.affiliation: Hospital de Clínicas, State University of Campinas, São Paulo, Brazil.
authors.forename: M d F T
authors.initials: Md
authors.lastname: Mei
authors.affiliation: Hospital de Clínicas, State University of Campinas, São Paulo, Brazil.
authors.forename: M E
authors.initials: ME
authors.lastname: Udo
authors.affiliation: Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil.
authors.forename: I F S F
authors.initials: IF
authors.lastname: Boin
authors.affiliation: Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil. Electronic address: stucchi.raquel@gmail.com.
authors.forename: R S B
authors.initials: RS
authors.lastname: Stucchi
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D058607:Fibric Acids / Q000009:adverse effects*; D006526:Hepatitis C / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents; D016898:Interferon-alpha / Q000009:adverse effects*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012206:Rhabdomyolysis / Q000139:chemically induced*; D012254:Ribavirin / Q000627:therapeutic use; D020123:Sirolimus / Q000009:adverse effects*
chemical_list: D000998:Antiviral Agents; D058607:Fibric Acids; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin; D016572:Cyclosporine; C019304:ciprofibrate; D020123:Sirolimus