Abstract
The calcineurin inhibitors (CIs) cyclosporine A and tacrolimus are essential for graft-versus-host disease prophylaxis but are associated with adverse effects, including neurotoxicity. We report a case of irreversible CI-induced neuropathic pain following allogeneic hematopoietic stem cell transplantation. The patient developed dysesthesia, electric shock-like pain, and severe itching followed by intractable analgesic-resistant pain in the lower extremities. There were no abnormal radiographic findings, and there was no improvement with a reduction of CI dosage or with administration of a calcium channel blocker. These clinical findings are similar to but inconsistent with CI-induced musculoskeletal pain syndromes previously reported in organ transplantation.
MeSH terms
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Adult
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Calcineurin Inhibitors*
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Cyclosporine / administration & dosage
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Cyclosporine / adverse effects*
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Female
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Graft vs Host Disease / diagnostic imaging
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Graft vs Host Disease / prevention & control
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Hematopoietic Stem Cell Transplantation* / adverse effects
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Humans
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Immunosuppressive Agents / administration & dosage
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Immunosuppressive Agents / adverse effects*
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Pain / chemically induced*
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Pain / diagnostic imaging
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Peripheral Nervous System Diseases / chemically induced*
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Peripheral Nervous System Diseases / diagnostic imaging
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / diagnostic imaging
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy
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Radiography
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Tacrolimus / administration & dosage
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Tacrolimus / adverse effects*
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Transplantation, Homologous
Substances
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Calcineurin Inhibitors
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Immunosuppressive Agents
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Cyclosporine
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Tacrolimus