Mycophenolate mofetil/sirolimus/tacrolimus
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Various toxicities: case report A woman in her 40’s [exact age at the time of reactions onsets not stated] developed cervical leiomyomata and residual high-grade cervical intraepithelial neoplasia (CIN) following immunosuppressive therapy with mycophenolate mofetil and tacrolimus. Subsequently, at the age of 48 years, she developed human papilloma virus infection and EpsteinBarr virus associated post-transplant lymphoproliferative disorder (PTLD) appearing in cervix following immunosuppressive therapy with mycophenolate mofetil, sirolimus and tacrolimus [routes, dosages and duration of treatments to reactions onsets not stated; not all outcomes stated]. The woman, who had end stage renal disease secondary to IgA nephropathy, underwent deceased donor kidney transplantation with thymo-induction 13 years previously. Subsequently, she had started receiving maintenance immunosuppressive therapy with tacrolimus and mycophenolate-mofetil. Eleven years after the transplantation, she exhibited abnormal Pap smear. Investigations revealed cervical leiomyomata and residual high-grade cervical intraepithelial neoplasia secondary to mycophenolate mofetil and tacrolimus. Therefore, the woman’s treatment with mycophenolatemofetil was discontinued, and tacrolimus was replaced with sirolimus 0.5mg daily. At 6 month follow-up, Pap smear was normal. However, at 1 year, the Pap smear was abnormal, with positive high-risk human papilloma virus. A cervical cone biopsy revealed polymorphic Epstein-Barr virus-associated PTLD rich in B and T cells. Therefore, the dose of sirolimus was decreased to 0.5mg every other day. After 3 months, the PTLD resolved as evidenced by the repeat biopsy of the cervix. Author comment: "Although Tacrolimus carries a significantly higher risk of PTLD, in our case, PTLD developed while on Sirolimus. Risk stratifications and optimal treatment strategies specific to kidney transplantation are lacking but immunosuppression reduction is the most accepted treatment and may result in resolution of the disease process as in our case." Sroya H, et al. A rare case of epstein-barr virus associated post-transplant lymphoproliferative disorder appearing in cervix. Journal of Hospital Medicine 13 803432767 (Suppl. 1): No. 4, 1 Jan 2018 [abstract] - USA
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Reactions 9 Nov 2019 No. 1778
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