Aims To evaluate the effect of corticosteroids on tacrolimus pharmacokinetics. Methods In a randomized trial, kidney transplant recipients were treated with tacrolimus and mycophenolate mofetil with either daclizumab ( n = 31) or 3 months of prednisone ( n = 34). Tacrolimus dose-adjusted predose concentrations ( C 0 ) at month 1-6 were compared between both groups and within the corticosteroid group before and after prednisone withdrawal. Results At month 1 the tacrolimus dose-adjusted C 0 in the corticosteroid group was 83 ± 8 vs 119 ± 17 ng ml -1 mg -1 kg -1 in the daclizumab group. The tacrolimus doseadjusted C 0 within the corticosteroid group at month 1 and 2 was 42% and 29% lower compared with month 4 ( P < 0.001). Conclusions A higher tacrolimus dose is required to reach target concentrations when used in combination with corticosteroids.

Oncogenic osteomalacia (or tumour-induced osteomalacia) is a rare paraneoplastic syndrome caused by overproduction of fibroblastic growth factor 23 (FGF-23) by tumours. Excessive production of FGF-23 can lead to severe, symptomatic hypophosphataemia. The majority of cases have been associated with benign tumours of bone or soft tissue, such as haemangiopericytomas or other neoplasms of mesenchymal origin. We present a case of a 68-year-old woman with an FGF-23 producing B cell non-Hodgkin's lymphoma. Treatment with immunochemotherapy resulted in normalisation of serum FGF-23 and phosphate levels.

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Clinical Pharmacology & Therapeutics (2003) 73, P81–P81; doi:

We describe an unusual case of blue toe syndrome as the primary and solitary manifestation of systemic sclerosis. The possible cause was long-term occupational exposure in construction work. Blue toe syndrome is a small vessel disease, characterised by the sudden development of painful, blue discolouration in one or more toes. The most common aetiology is atheroembolic disease; however, it can also appear in several conditions ranging from hypercoagulability disorders to underlying systemic diseases such as vasculitis or autoimmune diseases. Here, we describe the case of a 57-year-old man who presented with blue toe syndrome without underlying atheroembolic disease. He was found to have positive anticentromere antibodies, which indicated that systemic sclerosis was the likely primary underlying cause. An extensive systemic evaluation and a thorough physical examination revealed no other symptoms associated with systemic sclerosis. He was prescribed nifedipin and rosuvastatin, and showed complete resolution of symptoms after 3 months.