Tacrolimus Induced Diabetes Presenting As Recurrent Pyelonephritis – A Rare Clinical Presentation

Aditya Sudan,Ravi Kant,Vivek Mohanty

doi:10.24018/ejmed.2020.2.4.417

Abstract

Tacrolimus is immunosuppressive agent used in a variety of skin disorders including vitiligo. Systemic Tacrolimus has been known to cause diabetes by inducing insulin resistance and increasing the activity and expression of glucose transporter , SGLT1 . In addition to this Tacrolimus has direct beta cell toxicity and subsequent insulin secretory defects. Although systemic absorption of tropical Tacrolimus is minimal but cases have been reported where tropical use of Tacrolimus has been associated with the blood levels above therapeutic range causing potential toxicity . Here we highlight a interesting case of a 22 year old female who was on treatment with Tacrolimus ointment for Segmental Vitiligo presented with features of pyelonephritis with past history of similar recurrent episodes and on further investigations was diagnosed to have New Onset Diabetes Mellitus with elevated serum Tacrolimus levels suggesting Tacrolimus induced beta cell dysfunction and insulin resistance thus making it an interesting and rare presentation of potential toxicity.

Highlights

Tacrolimus is a macrolide antibiotic used an immunosuppressive agent which acts by inhibiting calcineurin which is involved in production of IL-2, a molecule required for the production and development of T cells [1]
Tropical tacrolimus has been found effective in vitiligo where it promotes pigmentation of depigmented areas possibly through affecting the local imbalance of cytokines profile which have found to have a role in vitiligo [3]
We highlight a interesting case of a 22 year old female who was on treatment with Topical Tacrolimus (0.1%) for vitiligo since last 5 years presented to our department with pain abdomen

Summary

INTRODUCTION

Tacrolimus is a macrolide antibiotic used an immunosuppressive agent which acts by inhibiting calcineurin which is involved in production of IL-2, a molecule required for the production and development of T cells [1] It has been effective in a variety of dermatological condition like atopic dermatitis, psoriasis, vitiligo, pyoderma gangrenosum, lichen planus [2]. Her past history revealed she had multiple similar episodes since the last 6 months for which she had undergone multiple hospitalisations. Her serum Tacrolimus levels was found to be above normal range (5-15 ng/ml) She was diagnosed to have Topical Tacrolimus induced New onset Diabetes Mellitus manifesting as recurrent pyelonephritis making it a rare and interesting presentation

CASE PRESENTATION

INVESTIGATIONS : Investigations

TREATMENT AND FOLLOW UP

CONCLUSION

Findings

DISCUSSION