Ciclosporin
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Repeated cerebral infarction in an elderly patient?: case report A 68-year-old man developed repeated cerebral infarctions during ciclosporin-based immunosuppression therapy for aplastic anaemia. The man, who was diagnosed with acquired severe aplastic anaemia, started immunosuppressive therapy with ciclosporin 5 mg/kg (300 mg/day), antithymocyte globulin, methylprednisolone and prednisone; he also received blood transfusions to correct his anaemia and thrombocytopenia. An allergic reaction to antithymocyte globulin resulted in high fever (40°C). On day 7 after therapy, he developed a left-sided sensory deficit, which led to a suspicion of an intracranial or subarachnoid haemorrhage. CT scans suggested the presence of old infarcts with no definite signs of haemorrhage. On day 13, he had a fever of 39°C and his blood culture results came back positive for Klebsiella oxytoca. An MRI on day 15 showed an acute infarction in the right thalamus. The following day, he developed left hemiparesis, and a repeat MRI showed a new infarct in the right pons. The man received edaravone daily for 2 weeks, in combination with platelet transfusions. He also received granulocyte colony-stimulating factors and daily IV cefepime for his K. oxytoca infection. His fever resolved on day 16, along with the other signs and symptoms of infection. Because of the possibility that ciclosporin could stimulate the cerebral infarcts and induce neurotoxicity, the trough concentrations of ciclosporin were maintained around the lower limit. There was no further progression of his neurological deficits. He was discharged after 63 days of hospitalisation, after rehabilitation and after his haematological parameters had recovered. Author comment: "[C]linical use of [ciclosporin] might invite the repeated cerebral infarctions." Suzuki R, et al. A case of acquired aplastic anemia with repeated cerebral infarctions at the beginning of immunosuppressive therapy. Tokai Journal of 803009338 Experimental and Clinical Medicine 34: 58-62, No. 3, 2009 - Japan
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Reactions 3 Apr 2010 No. 1295
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