Mycophenolate mofetil
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Acute inflammatory syndrome: case report A 36-year-old woman with systemic lupus erythematosus (SLE) developed acute inflammatory syndrome during maintenance therapy with mycophenolate mofetil (MMF). The woman started receiving MMF 500mg once daily, with a gradually dosage titration to 1000mg twice daily over 2 month. One month after reaching the maximal dose, she was admitted for subjective fevers and arthralgias, which had developed several days after the last dosage increase. She had an oral temperature of 99.9°F and synovitis of her wrists, ankles and knees. Laboratory investigations revealed the following levels and values: erythrocyte sedimentation rate (ESR) 114 mm/h, complement factor 4 10 mg/dL, WBC count 11 300/µL and creatinine phosphokinase (CPK) 13 U/L; urinalysis showed 0–2 RBCs, 0–2 WBCs, 3+ protein and trace blood. Arthrocentesis of her left knee disclosed a mildly inflammatory fluid. SLE exacerbation was suspected. MMF was stopped and the woman received corticosteroids. Her arthritis resolved the following day, and she was subsequently treated with cyclophosphamide for 4 months. The woman’s condition stabilised, and MMF 1000mg twice daily was restarted. Fatigue, fevers and arthralgias developed 2 days later. On presentation, she had an oral temperature of 99.0°F and synovitis; her WBC count and ESR were elevated, and her CPK level was decreased. MMF was permanently stopped, and her symptoms resolved within 3 days. Treatment was then changed to azathioprine, without recurrence of her symptoms over the next 10 months. Author comment: "Calculated Naranjo algorithm score . . . was 11. This makes an adverse drug reaction very likely in our patient, because a score >9 is consistent with a highly probable association. . . Our patient has a history of primary biliary cirrhosis. . . it is possible that subtle liver disease altered the normal hepatic metabolism and detoxication of MMF." Konon I, et al. Acute inflammatory syndrome following introduction of mycophenolate mofetil in a patient with systemic lupus erythematosus. Arthritis and Rheumatism: Arthritis Care and Research 59: 754-756, No. 5, 15 May 2008 801080827 USA
0114-9954/10/1200-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 3 May 2008 No. 1200
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