title: Idiosyncratic drug reactions and membranous glomerulopathy.
abstract: An infant boy with steroid-resistant nephrotic syndrome (idiopathic membranous glomerulonephropathy) achieved remission with ciclosporin but developed eosinophilia and high IgE levels (max 19 000  iU/mL). Conversion to tacrolimus resulted in chronic diarrhoea (eosinophilic gastroenteritis), muscle weakness, polyserositis and failure-to-thrive. In contrast, a trial without tacrolimus resulted in a ciclosporin-responsive relapse, therapy-resistant focal seizures with generalised spikes, worsening muscle weakness and diarrhoea. The patient was weaned off of ciclosporin and completely normalised. In vitro testing demonstrated decreased viability of the patient's cells when incubated with calcineurin inhibitors (ciclosporin, 70%; tacrolimus, 80% compared to control cells), supporting their role in this adverse drug reaction.
authors.affiliation: Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.
authors.forename: Amrit
authors.initials: A
authors.lastname: Kirpalani
authors.affiliation: Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rieder
authors.affiliation: Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Bax
authors.affiliation: Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.
authors.forename: Guido
authors.initials: G
authors.lastname: Filler
mesh_terms: D002470:Cell Survival; D016572:Cyclosporine / Q000009:adverse effects*; D000069340:Deprescriptions; D057915:Drug Substitution; D004751:Enteritis / Q000139:chemically induced*; D004802:Eosinophilia / Q000139:chemically induced*; D005183:Failure to Thrive / Q000139:chemically induced; D005756:Gastritis / Q000139:chemically induced*; D005885:Gingival Hyperplasia / Q000139:chemically induced; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D006983:Hypertrichosis / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D066298:In Vitro Techniques; D007223:Infant; D007678:Kidney Glomerulus / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D018908:Muscle Weakness / Q000139:chemically induced; D012640:Seizures / Q000139:chemically induced*; D012700:Serositis / Q000139:chemically induced; D016559:Tacrolimus / Q000009:adverse effects*; D014657:Vasculitis / Q000139:chemically induced*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus