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Cyclosporine A and amlodipine induced gingival overgrowth in a kidney transplant recipient: case presentation with literature review.
Nanda, T, Singh, B, Sharma, P, Arora, KS
BMJ case reports. 2019;(5)
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Abstract
Drug-induced gingival overgrowth is a condition caused by side effects of treatment with one of three types of drugs: phenytoin (used in epilepsy treatment), cyclosporine A (used in transplantology after allogenic organ transplants) and calcium channel blockers (used in the treatment of hypertension). Gingival overgrowth leads to inflammation within the gums and periodontium and can amplify the existing periodontal disease leading to tooth loss. Patients who have undergone kidney transplant are given immunosuppressants to prevent transplant rejection and mostly it is accompanied with calcium channel blockers to treat hypertension associated with kidney transplant. This article reports a case of recent gingival enlargement associated with cyclosporine A and amlodipine given to a kidney transplant patient from the past 11 years.
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2.
Cyclosporine for corticosteroid-refractory acute generalized exanthematous pustulosis due to hydroxychloroquine.
Castner, NB, Harris, JC, Motaparthi, K
Dermatologic therapy. 2018;(5):e12660
Abstract
Acute generalized exanthematous pustulosis most often manifests 1-2 days following exposure to a characteristic drug, such as aminopenicillins, calcium-channel blockers, or terbinafine. Recovery is usually rapid following drug withdrawal, and systemic corticosteroids represent the historic treatment of choice. Herein, acute generalized exanthematous pustulosis incited by hydroxychloroquine is briefly reviewed: a prolonged latency and recalcitrance to corticosteroids are noteworthy. In this unique context, cyclosporine tapered over several months is an effective therapeutic option.
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3.
Cyclosporine Reduces Sclerosis in Morphea: A Retrospective Study in 12 Patients and a Literature Review.
Bali, G, Frühauf, J, Wutte, N, Aberer, E
Dermatology (Basel, Switzerland). 2016;(4):503-10
Abstract
BACKGROUND The treatment of severe morphea is challenging, and treatment experience concerning the use of immunosuppressive agents for this condition is limited. OBJECTIVE The purpose of this study is to analyze the use of cyclosporine, its tolerability, and its effect on skin sclerosis. MATERIALS AND METHODS Patients with severe morphea who underwent treatment with cyclosporine were studied retrospectively. RESULTS Five of 12 patients with morphea showed complete remission and 6 patients had partial remission at the end of therapy (9-46 months, median 14) under a median cyclosporine dose of 2.4 mg/kg. The mean affected body surface area fell from 50% (2-80, median 65) to 17% (0-40, median 18). Side effects were hypertension, elevated transaminases, cholesterol, and weight gain. CONCLUSION Cyclosporine can be effective in morphea. The side effects were reversible. However, the duration of treatment with cyclosporine is limited because of its potential permanent side effects. Prospective placebo-controlled studies are needed to establish the superiority of cyclosporine over other immunosuppressive drugs in this setting.
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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.
dos Santos, AG, Guardia, AC, Pereira, TS, Ataíde, EC, Mei, Md, Udo, ME, Boin, IF, Stucchi, RS
Transplantation proceedings. 2014;(6):1887-8
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. CASE REPORT 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.
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[Successful treatment with cyclosporine for myelodysplastic syndrome with erythroid hypoplasia following rheumatoid arthritis].
Tsuji, T, Yamasaki, H, Tsuda, H
[Rinsho ketsueki] The Japanese journal of clinical hematology. 2010;(6):427-32
Abstract
A 65-year-old female was admitted to our hospital for evaluation of transfusion-dependent progressive anemia. She had a history of rheumatoid arthritis for twenty-four years. Two years earlier, MDS (refractory anemia) was diagnosed based on laboratory findings and bone marrow examination. After diagnosis, the patient received anabolic steroid, Vitamin D3 and Vitamin K2. Although her hemoglobin level was maintained at 8.0 g/dl approximately 9.0 g/dl until January 2009, anemia gradually progressed thereafter. In April, we recognized marked anemia (Hb 6.0 g/dl) and reticulocytopenia (2.0 per thousand), but this was not accompanied by any other significant changes in laboratory findings. Bone marrow examination demonstrated a low percentage of erythroid precursors without an increase of blast cells. Rheumatoid arthritis remained stable by low dose steroid and NSAID administration. We did not recognize evidence suggesting any other cause of acquired PRCA, such as thymoma, human parvovirus B19 infection or drugs. A diagnosis of MDS with erythroid hypoplasia was made. The patient was successfully treated by an immunosuppressive regimen using cyclosporine. MDS with erythroid hypoplasia, coexisting with rheumatoid arthritis, is rare. To our knowledge, this is the third reported case.
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[Successful treatment with cyclosporine of sodium valproate-induced pure red cell aplasia].
Kanda, J, Chonabayashi, K, Watanabe, M, Arima, N, Tsudo, M
[Rinsho ketsueki] The Japanese journal of clinical hematology. 2005;(10):1114-7
Abstract
We report a 67-year-old man who developed pure red cell aplasia (PRCA) during therapy for epilepsy with sodium valproate since April 2004. He was admitted to our hospital because of severe anemia (Hb 5.0g/dl, reticulocyte 0.1%) in August 2004. A bone marrow examination showed marked erythroid hypoplasia and a diagnosis of drug-induced PRCA was made. Because the discontinuation of valproate for one month failed to increase the number of reticulocytes and frequent blood transfusions were necessary, cyclosporine therapy was initiated. Within a week, substantial recovery of the numbers of reticulocytes was obtained, the cyclosporine had, however, to be changed to prednisolone due to the refusal of the patient to continue with it, resulting in the exacerbation of his anemia. After three weeks, cyclosporine therapy was resumed, which achieved rapid and remarkable recovery of red blood cells (Hb 8.9g/dl, reticulocyte 4.9%) within one month. Sixteen cases of valproate-induced PRCA have been reported in the literature and all cases except one recovered only by discontinuing or reducing the administration of valproate. However, our case required cyclosporine therapy in addition to the discontinuation of valproate. These results suggest that not only the direct toxic effect on erythropoiesis but also T lymphocyte-mediated immunological mechanism was involved in the pathogenesis of valproate-induced PRCA.
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7.
[Glucose intolerance induced by tacrolimus (FK506), cyclosporin A].
Ueda, K, Tanizawa, Y
Nihon rinsho. Japanese journal of clinical medicine. 2005;:333-7
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8.
Longstanding obliterative panarteritis in Kawasaki disease: lack of cyclosporin A effect.
Kuijpers, TW, Biezeveld, M, Achterhuis, A, Kuipers, I, Lam, J, Hack, CE, Becker, AE, van der Wal, AC
Pediatrics. 2003;(4):986-92
Abstract
Kawasaki disease is a childhood vasculitis of medium-sized vessels, affecting the coronary arteries in particular. We have treated a therapy-resistant child who met all diagnostic criteria for Kawasaki disease. After the boy was given intravenous immunoglobulins and salicylates, as well as several courses of pulsed methylprednisolone, disease recurred and coronary artery lesions became progressively detectable. Cyclosporin A was started and seemed clinically effective. In contrast to the positive effect on inflammatory parameters, ie, C-reactive protein and white blood cell counts, a novel plasma marker for cytotoxicity (granzyme B) remained elevated. Coronary disease progressed to fatal obstruction and myocardial infarction. Echocardiography, electrocardiograms, and myocardial creatine phosphokinase did not predict impending death. At autopsy an obliterative panarteritis was observed resulting from massive fibrointimal proliferation, affecting the aorta and several large and medium-sized arteries. Immunophenotypic analysis of the inflammatory infiltrates in arteries revealed mainly granzyme-positive cytotoxic T cells and macrophages in the intima and media, as well as nodular aggregates of T cells, B cells, and plasma cells in the adventitia of affected arteries. These findings further endorse the role of specific cellular and humoral immunity in Kawasaki disease. Unremitting coronary arteritis and excessive smooth muscle hyperplasia resulted in coronary occlusion despite the use of cyclosporin A.
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Cyclosporine-associated hyperkalemia: report of four allogeneic blood stem-cell transplant cases.
Caliskan, Y, Kalayoglu-Besisik, S, Sargin, D, Ecder, T
Transplantation. 2003;(7):1069-72
Abstract
BACKGROUND Nephrotoxicity is a well-known effect of cyclosporine (CsA) that causes a reduction in glomerular filtration rate through vasoconstriction of the afferent glomerular arterioles and may result in acute renal failure. Isolated CsA-induced hyperkalemia occurring through different mechanisms is also common. However, there are only a few "case reports" addressing this phenomenon in allogeneic bone marrow transplantation patients. In this report, we propose mechanisms and methods of managing CsA-associated hyperkalemia in allogeneic transplantation. METHODS We report on four allogeneic blood stem- cell transplant cases and a review of the literature. RESULTS Four adult leukemia patients underwent allogeneic peripheral blood stem cell transplantation and received CsA as a part of their graft-versus-host disease prophylaxis. The patients developed hyperkalemia, despite adequate kidney function. CsA seemed to be the only pharmaceutical agent to which this electrolyte abnormality could be attributed. Renal tubule dysfunction and secondary hypoaldosteronism seemed to be the reasons for CsA-associated hyperkalemia. CONCLUSION This report of four cases demonstrates that CsA should be considered among the possible causes of hyperkalemia in bone marrow transplantation. There may be a need for urgent intervention depending on the severity of hyperkalemia. Monitoring of blood CsA level and dose adjustment are important for the prevention of this complication.
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10.
Treatment with cyclosporin in patients with psoriatic arthritis: results of clinical assessment.
Raffayová, H, Rovenský, J, Mális, F
International journal of clinical pharmacology research. 2000;(1-2):1-11
Abstract
An open 18-week study with a preparation of cyclosporin administered to patients with psoriatic arthritis confirmed the therapeutic efficacy of the preparation. Given the low frequency of adverse effects (at the initial and maintenance daily dose), the preparation could also be considered relatively safe. A pronounced improvement in psoriatic symptoms was observed during the study. As early as 2 weeks after administration of an average daily dose of cyclosporin A of 4.8 mg/kg, skin symptoms improved by 65.5%. The most intense effect on the activity of arthritis was observed after 18 weeks. The lowest optimal effective maintenance dose was 3.26 mg/kg/day. Improvement was achieved after an average of 10 weeks' cyclosporin administration.