Calcineurin Inhibitor-Induced Pain Syndrome: An Uncommon but a Debilitating Complication of Calcineurin Inhibitors Use
Calcineurin Inhibitor-Induced Pain Syndrome: An Uncommon but a Debilitating Complication of Calcineurin Inhibitors Use
复制标题
钙调神经磷酸酶抑制剂引起的疼痛综合征：一种罕见但令人衰弱的使用钙调神经磷酸酶抑制剂的并发症
DOI：
10.4103/1319-2442.352443
复制
发表时间：
2021
影响因子：
0.5
通讯作者：
I. Alahmadi
中科院分区：
文献类型：
--
作者：
Asad Ullah;Ahmed Aly;Tariq Ali;I. Alahmadi
使用钙调磷酸酶抑制剂（CNI）可以显著改善肾移植的预后。然而，这种改善是以副作用为代价的。cni诱导的疼痛综合征（CIPS）是一种良性但致残的疼痛综合征。它特别影响下肢。我们报告一例年轻男性肾移植受者。患者在移植后4个月出现双侧下肢疼痛加重。诱导治疗为basiliximab。他克莫司、类固醇和霉酚酸酯构成维持免疫抑制治疗。疼痛影响到两侧的脚踝和脚趾。它开始时是逐渐的，但在四周内不断恶化。持续的疼痛在一定程度上影响了他的行动能力，以至于他不得不依赖轮椅。对乙酰氨基酚和可待因对疼痛无反应。没有进行正式的精神病学评估，但患者报告的抑郁症状与他的活动能力下降有关。经检查，患者受累部位有骨压痛，被动活动范围良好。下肢神经及血管检查无明显差异。排除关节疼痛的炎症和感染原因。足部磁共振成像（MRI）显示骨髓水肿特征。他被诊断为CIPS。免疫抑制由他克莫司改为环孢素。诊断后也使用普瑞巴林。一个月后症状逐渐好转。他开始用拐杖走路，后来没有任何帮助。在此期间，肾移植功能保持稳定。足部MRI扫描，5个月后症状显示骨髓水肿消退。CIPS是CNI的一种少见、良性但致残的并发症。及早发现可以减轻症状（身体和心理）的负担和生产力的损失。CIPS的管理没有证据基础，需要在这一治疗领域进行进一步的研究。
The outcomes of renal transplantation have improved significantly with the use of calcineurin inhibitors (CNI). However, this improvement comes at the price of side effects. CNI-induced pain syndrome (CIPS) is a benign but disabling painful syndrome. It particularly affects the lower limbs. We present the case of a young male renal transplant recipient. He presented with worsening bilateral lower limb pain four months after transplantation. Induction therapy was basiliximab. Tacrolimus, steroids, and mycophenolate mofetil constituted maintenance immunosuppressive therapy. Pain affected the ankles and toes bilaterally. It started gradually but progressed over four weeks. The relentless pain affected his mobility to an extent that he became wheel chair dependent. Pain was unresponsive to paracetamol and codeine. No formal psychiatry assessment was done but patient-reported depression symptoms related to his reduced mobility. On examination, he had bony tenderness over the affected areas with the good range of passive movements. Neurological and vascular examinations of lower limbs were unremarkable. Inflammatory and infective causes of joint pain were excluded. Magnetic resonance imaging (MRI) feet showed the features of bone marrow edema. He was diagnosed with CIPS. Immunosuppression was changed from tacrolimus to cyclosporine. Pregabalin was also introduced after the diagnosis. Symptoms improved gradually over a month. He started to walk with a stick initially and then without any aid. Renal transplant function remained stable throughout this period. MRI feet scan, five months after the symptoms showed resolution of the bone marrow edema. CIPS is an uncommon, benign but disabling complication of CNI. Recognizing it early could limit the burden of symptoms (both physical and psychological) and loss of productivity. The management of CIPS is not evidence based and further research is required in this therapeutic area.