Ponte Gaston M, Baidal David A, Romanelli Paolo, Faradji Raquel N, Poggioli Raffaella, Cure Pablo, Froud Tatiana, Selvaggi Gennaro, Pileggi Antonello, Ricordi Camillo, Alejandro Rodolfo
Diabetes Research Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA.
Cell Transplant. 2007;16(1):23-30. doi: 10.3727/000000007783464524.
Tacrolimus is an immunosuppressive agent used in solid organ and islet transplantation. Its topical form has shown benefit in the treatment of inflammatory skin conditions. Although tacrolimus has a wide spectrum of side effects, dermatological complications related to systemic tacrolimus therapy are limited in the literature. Atopic dermatitis (AD) is a chronic pruritic cutaneous condition that usually begins in infancy and is characterized by an increased Th2 response. We report the case of a patient with type 1 diabetes mellitus (T1DM) and history of AD latent for 10 years who developed severe dermatitis and alopecia 5 months after undergoing allogeneic islet transplantation and initiating a steroid-free immunosuppressive regimen with sirolimus and tacrolimus maintenance. After exclusion of other possible causes for the progression and exacerbation of the clinical presentation of AD, discontinuation of tacrolimus and introduction of mycophenolate mofetil resulted in full remission of the symptoms. The beneficial effects of tacrolimus withdrawal suggest a cause-effect relationship between this adverse event and the utilization of the drug. Islet graft function remained stable after modification of the therapeutic regimen (stable glycemic control and unchanged C-peptide).
他克莫司是一种用于实体器官和胰岛移植的免疫抑制剂。其局部用药形式已显示出对炎症性皮肤病的治疗益处。尽管他克莫司有广泛的副作用，但与全身他克莫司治疗相关的皮肤并发症在文献中报道较少。特应性皮炎（AD）是一种慢性瘙痒性皮肤病，通常始于婴儿期，其特征为Th2反应增强。我们报告了1例1型糖尿病（T1DM）患者，有10年AD病史，在接受同种异体胰岛移植并开始使用西罗莫司和他克莫司维持的无类固醇免疫抑制方案5个月后，出现严重皮炎和脱发。在排除AD临床表现进展和加重的其他可能原因后，停用他克莫司并引入霉酚酸酯导致症状完全缓解。停用他克莫司的有益效果表明该不良事件与药物使用之间存在因果关系。调整治疗方案后胰岛移植功能保持稳定（血糖控制稳定且C肽不变）。
