Goklemez Sencer, Curtis Lauren M, Hawwa Alao, Ling Alexander, Avila Daniele, Heller Theo, Pavletic Steven Z
Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Translational Hepatology Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Mayo Clin Proc Innov Qual Outcomes. 2017 Aug 2;1(2):198-201. doi: 10.1016/j.mayocpiqo.2017.06.004. eCollection 2017 Sep.
Calcineurin inhibitors (CNIs) are effective agents used for prevention of graft-vs-host disease after allogeneic hematopoietic stem cell transplant or for organ rejection in solid-organ transplant. However, CNIs have a wide range of adverse effects that may necessitate changing to another CNI or immunosuppressive agent. We report a case of acute myeloid leukemia in which achalasia developed after exposure to tacrolimus, as revealed by esophagram results. The patient's symptoms and signs were ameliorated after a change to cyclosporine. This case is the first in the literature to reveal achalasia associated with tacrolimus. Achalasia should be part of a differential diagnosis of upper gastrointestinal symptoms in patients undergoing transplant, and changing to another CNI may be a useful therapeutic intervention.
钙调神经磷酸酶抑制剂（CNIs）是用于预防异基因造血干细胞移植后移植物抗宿主病或实体器官移植中器官排斥反应的有效药物。然而，CNIs有广泛的不良反应，可能需要更换为另一种CNI或免疫抑制剂。我们报告一例急性髓系白血病患者，食管造影结果显示，其在接触他克莫司后出现了贲门失弛缓症。更换为环孢素后，患者的症状和体征有所改善。该病例是文献中首例揭示与他克莫司相关的贲门失弛缓症。贲门失弛缓症应作为移植患者上消化道症状鉴别诊断的一部分，更换为另一种CNI可能是一种有效的治疗干预措施。
