title: Calcineurin Inhibitor-Induced Pain Syndrome in ABO-Incompatible Living Kidney Transplantation: A Case Report.
abstract: BACKGROUND
  Calcineurin-inhibitor-induced pain syndrome (CIPS) was used as a reference in the literature as reflex sympathetic dystrophy syndrome related to calcineurin inhibitors. Much of the literature describes CIPS that occurred after kidney and bone marrow transplantation. We describe a rare case of CIPS in induction immunosuppression before kidney transplantation, under administration of an anti-rheumatoid drug.
  
  
  METHODS
  A 53-year-old woman had pre-status of ABO-incompatible living kidney transplantation. The patient had rheumatoid arthritis, but that was well-controlled with salazosulfapyridine as an anti-rheumatoid drug. Fourteen days before transplantation, she received induction immunosuppressive therapy consisting of tacrolimus (TAC) and mycophenolate mofetil (MMF) and she stopped taking salazosulfapyridine. The third day after that treatment, she had a high fever, fatigue, and joint pains of the knees, elbows, and wrists.
  
  
  RESULTS
  When the patient stopped taking TAC and MMF and started taking salazosulfapyridine again, she soon recovered. Next, we challenged same induction immunosuppression therapy with administration of salazosulfapyridine; however, the patient had the same symptom. We considered that the symptom was caused by TAC or MMF, and we did not challenge-test each drug. We found that taking only TAC caused the same symptom for the patient. Also, we challenged cyclosporine (CsA) with MMF and confirmed that she did not have the symptom.
  
  
  CONCLUSIONS
  We decided that drugs of the induction immunosuppression therapy were CsA, MMF, prednisolone, and basiliximab. The patient received induction therapy with plasmapheresis and rituximab in addition to the above-mentioned drugs, and we performed ABO-incompatible kidney transplantation for her. The post-surgical course was good, without acute rejection, and she had no pain.
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: showhey@med.nagoya-u.ac.jp.
authors.forename: S
authors.initials: S
authors.lastname: Ishida
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Funahashi
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sassa
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Matsukawa
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshino
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Katsuno
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Maruyama
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Gotoh
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D018771:Arthralgia / Q000139:chemically induced*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D000077552:Basiliximab; D001787:Blood Group Incompatibility; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D010956:Plasmapheresis; D011300:Preoperative Care; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D000069283:Rituximab / Q000627:therapeutic use; D012460:Sulfasalazine / Q000627:therapeutic use; D016559:Tacrolimus / Q000009:adverse effects*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D065095:Calcineurin Inhibitors; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D012460:Sulfasalazine; D000069283:Rituximab; D016572:Cyclosporine; D000077552:Basiliximab; D009173:Mycophenolic Acid; D016559:Tacrolimus