Tacrolimus
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Post-transplant allergy or immune-mediated disease: 8 case reports In a retrospective study consisting of patients who switched from tacrolimus therapy to sirolimus from 2000 to 2017, eight patients (six males and two females) aged 1.4–9 years were described, who developed post-transplant allergy or immune-mediated disease (PTAID) in the form of leukocytoclastic vasculitis, Henoch-Schonlein purpura (HSP)-like rash, eczema, multiple food allergies, eosinophilic colitis, oligoarthritis, panniculitis or eosinophilic oesophagitis following treatment with tacrolimus as immunosuppressant therapy [routes and dosages not stated]. Patient 1: A 9-year-old boy developed PTAID in the form of leukocytoclastic vasculitis and HSP-like rash during treatment with tacrolimus as immunosuppressant therapy. The boy, who had biliary atresia, underwent deceased donor liver transplantation at the age of 12 months. He started receiving immunosuppression therapy with tacrolimus. At the age of 9 years (8 years after the transplantation), he developed PTAID with leukocytoclastic vasculitis and HSP-like rash. Skin biopsy confirmed the diagnosis of PTAID, which was considered as secondary to tacrolimus therapy. He was treated with unspecified allergy or immune-mediated disease therapies. No improvement was observed. Twenty-two months after the presentation with PTAID, his tacrolimus therapy was changed to sirolimus. Within 4 months, his PTAID completely resolved. Patient 2: A 3-year-old girl developed PTAID in the form of eczema during treatment with tacrolimus as immunosuppressant therapy. The girl, who had α-1-antitrypsin deficiency, underwent living donor liver transplantation at the age of 12 months. She started receiving immunosuppression therapy with tacrolimus. At the age of 3 years (24 months after the transplantation), she developed eczema. She was diagnosed as PTAID, and considered as secondary to tacrolimus therapy. She was treated with unspecified skin barrier creams, moisturising cream, steroid cream and antihistamine agents. No improvement was observed. Eight months after the presentation with PTAID, her tacrolimus therapy was changed to sirolimus. Despite treatment with sirolimus, no change in her PTAID was noted. Patient 3: A 1.7-year-old girl developed PTAID in the form of multiple food allergies following treatment with tacrolimus as immunosuppressant therapy. The girl, who had McCune Albright syndrome with neonatal cholestasis, underwent living donor liver transplantation at the age of 10 months. She started receiving immunosuppression therapy with tacrolimus. Her concomitant medications consisted of cotrimoxazole and aspirin. At the age of 1.7 years (7 months after the transplantation), she developed multiple food allergies consisting of allergy to milk, egg, wheat, sesame and chickpea. Skin prick test led to the diagnosis of PTAID, considered as secondary to tacrolimus therapy. Two years after the presentation of PTAID, her tacrolimus therapy was switched to sirolimus. Despite treatment with sirolimus, no change in her
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