Calcineurin inhibitor-induced pain syndrome after kidney transplantation--a rare but disabling condition

Abstract

Kidney transplantation represents the preferred treatment for ESRD. Nevertheless, the use of the essential immunosuppressive agents may be associated with various side effects. In addition to frequently encountered complications such as post-transplantation diabetes, infections or calcineurin inhibitor (CNI) nephrotoxicity, a wide variety of rare conditions have to be dealt with. Musculoskeletal pain after kidney transplantation is most often a manifestation of high-dose steroid therapy, steroid withdrawal, renal osteodystrophy or osteoporosis. Apart from these common causes, cyclosporine intake was identified for the first time as a novel reason for severe skeletal pain in 1989. It has been reported that cyclosporine may induce bone marrow oedema leading to severe and disabling bone pain mainly located in the lower limbs. Due to its relation to high CNI serum levels, the syndrome was named calcineurin inhibitor-induced pain syndrome (CIPS) by Grotz and colleagues in 2001. Here, we report a patient who suffered from progressive disabling bilateral pain in his feet and knees due to CIPS evolving 2 months after kidney transplantation.