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Tacrolimus-induced diabetic ketoacidosis with subsequent rapid recovery of endogenous insulin secretion after cessation of tacrolimus: A case report with review of literature.
Maruyama, K, Chujo, D
Medicine. 2019;(36):e16992
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Abstract
RATIONALE Immunosuppressive agents such as tacrolimus (TAC) and cyclosporin might cause glycemic disorders by suppressing insulin production. However, only a few cases of diabetic ketoacidosis (DKA) with longitudinal evaluation of endogenous insulin secretion related to TAC administration have been reported. PATIENT CONCERNS A 59-year-old Asian woman, who received prednisolone and TAC 4.0 mg for the treatment of anti-aminoacyl-tRNA synthetase antibody-positive interstitial pneumonia, was admitted to our hospital due to impaired consciousness and general malaise. DIAGNOSES She had metabolic acidosis; her plasma glucose, fasting serum C-peptide immunoreactivity (CPR), and urinary CPR levels were 989 mg/dL (54.9 mmol/L), 0.62 ng/mL, and 13.4 μg/d, respectively. No islet-related autoantibodies were detected. Therefore, she was diagnosed with TAC-induced DKA. INTERVENTION Intravenous continuous insulin infusion and rapid saline infusion were administered. TAC was discontinued because of its diabetogenic potential. OUTCOMES Sixteen weeks after cessation of TAC administration, she showed good glycemic control without administration of insulin or any oral hypoglycemic agents; her serum CPR level also improved dramatically. These findings suggested that TAC-induced pancreatic beta cell toxicity is reversible. LESSONS We reported a case of TAC-induced DKA with subsequent recovery of pancreatic beta cell function after cessation of TAC, resulting in good glycemic control. As TAC is widely used, we should pay attention to patients' glucose levels even though the TAC concentrations used are within the target range. Furthermore, dose reduction or cessation of TAC should be considered if hyperglycemia is detected during administration of this agent.
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Colchicine-Induced Myopathy in a Tacrolimus-Treated Renal Transplant Recipient: Case Report and Literature Review.
Yousuf Bhat, Z, Reddy, S, Pillai, U, Doshi, M, Wilpula, E
American journal of therapeutics. 2016;(2):e614-6
Abstract
Renal transplant recipients are prone to develop drug toxicities because of polypharmacy and drug-drug interactions. Colchicine is often used for the treatment of gout in these patients as nonsteroidal medications are contraindicated. In addition, patients are often on corticosteroids and frequent, periodic, dose escalation for gouty flare may lead to side effects. Colchicine-induced myopathy has been very well described in the literature. Several cases of colchicine toxicity have been reported in cyclosporine-treated patients due to a drug-drug interaction. We report a 62-year-old African American renal transplant recipient who had been doing well on tacrolimus-based immunosuppression and was started on colchicine (0.6 mg twice daily) for gouty flare. A few days later, he was found to have a 4-fold increase in aspartate aminotransferase and an elevated creatine phosphokinase. Although this interaction is very well known with cyclosporine, it has not yet been reported in patients on tacrolimus.
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Calcipotriol/betamethasone dipropionate ointment compared with tacrolimus ointment for the treatment of erosive pustular dermatosis of the scalp: a split-lesion comparison.
Pagliarello, C, Fabrizi, G, Fantini, C, Cortelazzi, C, Boccaletti, V, Annessi, G, Zampetti, A, Feliciani, C, Di Nuzzo, S
European journal of dermatology : EJD. 2015;(2):206-8
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Tako-tsubo cardiomyopathy on the first day after renal transplantation - case report and literature review.
Gołębiewska, J, Stopczyńska, I, Dębska-Ślizień, A, Bohdan, M, Gruchała, M, Rutkowski, B
Transplantation proceedings. 2014;(8):2920-2
Abstract
BACKGROUND The etiology of tako-tsubo cardiomyopathy, defined as a transient left ventricular dysfunction in the absence of significant coronary artery stenosis, still remains unclear. This syndrome mainly occurs in postmenopausal women and is often associated with emotional stress or miscellaneous diagnostic and therapeutic procedures. Estimated prevalence of tako-tsubo cardiomyopathy is found in 1% to 2% of patients presenting with suspected acute coronary syndrome. So far there has been only one case report of tako-tsubo cardiomyopathy in a renal transplant recipient. CASE REPORT We describe the case of a 68-year-old woman with a history of coronary artery disease and coronary artery bypass grafting in whom unspecific transient chest pain and hypotension were observed on the first day after renal transplantation. After transplantation, the patient was anuric with pulmonary congestion and toxic tacrolimus concentrations were observed. Electrocardiogram showed sinus rhythm with left bundle branch block (LBBB) that has not been described before. Plasma cardiac necrosis markers troponin I and creatine kinase MB were mildly elevated. Echocardiography showed severe left ventricular function impairment with characteristic shape of left ventricle. Subsequent cardiac catheterization revealed the absence of angiographic evidence of acute plaque rupture within both coronary arteries and bypass grafts. During the next few days there was marked clinical improvement with resolution of LBBB and full recovery of all biochemical parameters. On discharge, full functional recovery of the left ventricle in echocardiography was observed. Postulated mechanisms of tako-tsubo cardiomyopathy include catecholamine excess, coronary artery spasm, and microvascular dysfunction. On the other hand calcineurin inhibitors are known factors causing coronary epicardial endothelial dysfunction and negatively affecting vasomotor function. CONCLUSIONS Tako-tsubo cardiomyopathy in patients after renal transplantation may be at least in part a manifestation of calcineurin inhibitor cardiotoxicity.
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A patient with Takayasu's arteritis and rheumatoid arthritis who responded to tacrolimus hydrate.
Yokoe, I, Haraoka, H, Harashima, H
Internal medicine (Tokyo, Japan). 2007;(22):1873-7
Abstract
We encountered the rare case of a 50-year-old woman who developed rheumatoid arthritis (RA) while suffering from Takayasu's arteritis of arch vessel type. prednisolone (PSL) therapy was continued at a maintenance dose of 7.5 mg due to recurring inflammation. She was affected with RA for 7 years after Takayasu's arteritis. Disease-modifying antirheumatic drugs (DMARDs) were unusable because of side effects. In the summer of 2005, RA activity increased, and treatment with tacrolimus hydrate at 1.5 mg was started; thereafter, the activity of RA and Takayasu's arteritis was relieved, especially MRA findings. We report that therapy with tacrolimus hydrate markedly relieved two disorders, and review the literature.
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[Glucose intolerance induced by tacrolimus (FK506), cyclosporin A].
Ueda, K, Tanizawa, Y
Nihon rinsho. Japanese journal of clinical medicine. 2005;:333-7