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Pain syndrome with stress fractures in transplanted patients treated with calcineurin inhibitors.

Gurin L, Gohh R, Evangelista P - Clin Kidney J (2012)

Bottom Line: Calcineurin inhibitor-induced pain syndrome (CIPS) is a reversible etiology of lower extremity bone pain and bone marrow edema reported in patients receiving cyclosporine or tacrolimus after solid organ or bone marrow transplantation.While the syndrome's pathophysiology is unclear, bone insufficiency and epiphyseal impaction may play a role.We review the literature on this increasingly important post-transplant entity and describe a case illustrating the syndrome's key features.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology and Psychiatry, New York University School of Medicine, New York, NY.

ABSTRACT
Bone disease remains a major cause of morbidity after renal transplantation. Post-transplant osseous complications include osteoporosis and osteonecrosis, both historically associated with glucocorticoids, and a newer syndrome of bone pain associated with calcineurin inhibitors. Calcineurin inhibitor-induced pain syndrome (CIPS) is a reversible etiology of lower extremity bone pain and bone marrow edema reported in patients receiving cyclosporine or tacrolimus after solid organ or bone marrow transplantation. While the syndrome's pathophysiology is unclear, bone insufficiency and epiphyseal impaction may play a role. We review the literature on this increasingly important post-transplant entity and describe a case illustrating the syndrome's key features.

No MeSH data available.


Related in: MedlinePlus

A 59-year-old woman post-renal transplant with bilateral knee and ankle pain. Sagittal T1 (A) and sagittal STIR (B) of the left ankle, sagittal STIR of the right ankle (C), coronal T1 (D) and STIR (E) of the bilateral knees demonstrates patchy marrow edema in the bilateral calcanei, talus, distal femora and proximal/distal tibia. In addition, an incomplete left calcaneal stress fracture is demonstrated (arrow in A, B). A normal MR imaging of the knee (F) is shown for comparison.
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fig1: A 59-year-old woman post-renal transplant with bilateral knee and ankle pain. Sagittal T1 (A) and sagittal STIR (B) of the left ankle, sagittal STIR of the right ankle (C), coronal T1 (D) and STIR (E) of the bilateral knees demonstrates patchy marrow edema in the bilateral calcanei, talus, distal femora and proximal/distal tibia. In addition, an incomplete left calcaneal stress fracture is demonstrated (arrow in A, B). A normal MR imaging of the knee (F) is shown for comparison.

Mentions: MR imaging of the patient’s ankles 2 weeks later revealed bilateral calcaneal incomplete stress fractures, in addition to patchy areas of bone marrow edema in the medial talar head and posterolateral tibia (Figure 1A–C). MR imaging of the patient’s knees also revealed patchy areas of marrow edema involving the bilateral distal femoral and proximal tibial metaphyseal regions (Figure 1D and E). These findings, in the setting of tacrolimus therapy, were consistent with a diagnosis of CIPS.


Pain syndrome with stress fractures in transplanted patients treated with calcineurin inhibitors.

Gurin L, Gohh R, Evangelista P - Clin Kidney J (2012)

A 59-year-old woman post-renal transplant with bilateral knee and ankle pain. Sagittal T1 (A) and sagittal STIR (B) of the left ankle, sagittal STIR of the right ankle (C), coronal T1 (D) and STIR (E) of the bilateral knees demonstrates patchy marrow edema in the bilateral calcanei, talus, distal femora and proximal/distal tibia. In addition, an incomplete left calcaneal stress fracture is demonstrated (arrow in A, B). A normal MR imaging of the knee (F) is shown for comparison.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400457&req=5

fig1: A 59-year-old woman post-renal transplant with bilateral knee and ankle pain. Sagittal T1 (A) and sagittal STIR (B) of the left ankle, sagittal STIR of the right ankle (C), coronal T1 (D) and STIR (E) of the bilateral knees demonstrates patchy marrow edema in the bilateral calcanei, talus, distal femora and proximal/distal tibia. In addition, an incomplete left calcaneal stress fracture is demonstrated (arrow in A, B). A normal MR imaging of the knee (F) is shown for comparison.
Mentions: MR imaging of the patient’s ankles 2 weeks later revealed bilateral calcaneal incomplete stress fractures, in addition to patchy areas of bone marrow edema in the medial talar head and posterolateral tibia (Figure 1A–C). MR imaging of the patient’s knees also revealed patchy areas of marrow edema involving the bilateral distal femoral and proximal tibial metaphyseal regions (Figure 1D and E). These findings, in the setting of tacrolimus therapy, were consistent with a diagnosis of CIPS.

Bottom Line: Calcineurin inhibitor-induced pain syndrome (CIPS) is a reversible etiology of lower extremity bone pain and bone marrow edema reported in patients receiving cyclosporine or tacrolimus after solid organ or bone marrow transplantation.While the syndrome's pathophysiology is unclear, bone insufficiency and epiphyseal impaction may play a role.We review the literature on this increasingly important post-transplant entity and describe a case illustrating the syndrome's key features.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology and Psychiatry, New York University School of Medicine, New York, NY.

ABSTRACT
Bone disease remains a major cause of morbidity after renal transplantation. Post-transplant osseous complications include osteoporosis and osteonecrosis, both historically associated with glucocorticoids, and a newer syndrome of bone pain associated with calcineurin inhibitors. Calcineurin inhibitor-induced pain syndrome (CIPS) is a reversible etiology of lower extremity bone pain and bone marrow edema reported in patients receiving cyclosporine or tacrolimus after solid organ or bone marrow transplantation. While the syndrome's pathophysiology is unclear, bone insufficiency and epiphyseal impaction may play a role. We review the literature on this increasingly important post-transplant entity and describe a case illustrating the syndrome's key features.

No MeSH data available.


Related in: MedlinePlus