Department of Pancreas and Kidney Transplantation, Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, , SaudArabia.
Saudi J Kidney Dis Transpl. 2021 Nov-Dec;32(6):1795-1799. doi: 10.4103/1319-2442.352443.
The outcomes of renal transplantation have improved significantly with the use of calcineurin inhibitors (CNI). However, this improvement comes at the price of side effects. CNI-induced pain syndrome (CIPS) is a benign but disabling painful syndrome. It particularly affects the lower limbs. We present the case of a young male renal transplant recipient. He presented with worsening bilateral lower limb pain four months after transplantation. Induction therapy was basiliximab. Tacrolimus, steroids, and mycophenolate mofetil constituted maintenance immunosuppressive therapy. Pain affected the ankles and toes bilaterally. It started gradually but progressed over four weeks. The relentless pain affected his mobility to an extent that he became wheel chair dependent. Pain was unresponsive to paracetamol and codeine. No formal psychiatry assessment was done but patient-reported depression symptoms related to his reduced mobility. On examination, he had bony tenderness over the affected areas with the good range of passive movements. Neurological and vascular examinations of lower limbs were unremarkable. Inflammatory and infective causes of joint pain were excluded. Magnetic resonance imaging (MRI) feet showed the features of bone marrow edema. He was diagnosed with CIPS. Immunosuppression was changed from tacrolimus to cyclosporine. Pregabalin was also introduced after the diagnosis. Symptoms improved gradually over a month. He started to walk with a stick initially and then without any aid. Renal transplant function remained stable throughout this period. MRI feet scan, five months after the symptoms showed resolution of the bone marrow edema. CIPS is an uncommon, benign but disabling complication of CNI. Recognizing it early could limit the burden of symptoms (both physical and psychological) and loss of productivity. The management of CIPS is not evidence based and further research is required in this therapeutic area.
环孢素抑制剂（CNI）的使用显著改善了肾移植的效果。然而，这一改善是以副作用为代价的。CNI 诱导的疼痛综合征（CIPS）是一种良性但致残性的疼痛综合征。它特别影响下肢。我们报告了一例年轻男性肾移植受者的病例。他在移植后四个月出现双侧下肢疼痛加重。诱导治疗是巴利昔单抗。他克莫司、类固醇和霉酚酸酯构成维持性免疫抑制治疗。疼痛影响双侧踝关节和脚趾。疼痛逐渐开始，但在四周内逐渐加重。持续的疼痛严重影响了他的行动能力，使他不得不依赖轮椅。疼痛对扑热息痛和可待因无反应。虽然没有进行正式的精神病学评估，但患者报告的与活动减少相关的抑郁症状。体格检查发现，受累部位有骨压痛，被动活动度良好。下肢的神经和血管检查无异常。排除了关节痛的炎症和感染性原因。足部磁共振成像（MRI）显示骨髓水肿的特征。他被诊断为 CIPS。免疫抑制从他克莫司改为环孢素。诊断后还引入了普瑞巴林。症状在一个月内逐渐改善。他最初用拐杖行走，然后无需任何帮助。在此期间，肾移植功能保持稳定。症状出现五个月后，足部 MRI 扫描显示骨髓水肿已消退。CIPS 是 CNI 的一种罕见、良性但致残性并发症。早期识别可以减轻症状（身体和心理）和丧失生产力的负担。CIPS 的治疗尚缺乏循证医学证据，需要在这一治疗领域开展进一步研究。
