Acute Renal Failure Caused by Imiquimod 5% Cream in a Renal Transplant Patient: Review of the Literature on Side Effects of Imiquimod

Abstract

Imiquimod is an immunomodulator of the imidazoquinoline group which possesses antiviral and antitumour activities. Although its mechanism of action has not been entirely elucidated yet, imiquimod 5% cream has been shown to be an efficient, long-lasting and safe therapy for multiple actinic keratoses in non-immunosuppressed patients and in transplant recipients. We report the case of a 44-year-old patient with a third renal transplant who developed an acute tubular necrosis confirmed by renal biopsy after the use of imiquimod 5% cream. The result of a literature search revealed a wide variety of side effects attributable to the use of imiquimod.

Research gaps in the management and prevention of cutaneous squamous cell carcinoma in organ transplant recipients

“…Additionally, there is a risk of cytokine release syndrome when applied over a large surface area and further studies are needed to determine this risk . Imiquimod is used in OTR with caution owing to the possible risk of increasing immunoreactivity and organ rejection . 5‐FU interferes with cellular DNA synthesis, with resultant cell death.…”

Isotretinoin and candida immunotherapy for recalcitrant warts in solid organ transplant recipients

“…Increased levels of creatinine have been described in renal transplant recipients treated with imiquimod. There are also reports of acute renal failure (Santos‐Juanes et al, ) but the theoretical risk of inducing graft rejection has not been validated (Kovach & Stasko, ). Intralesional immunotherapy with Candida antigen has been shown to be superior to cryotherapy for the treatment of warts in immunocompetent patients (Khozeimeh et al, ).…”

Local interventions for actinic keratosis in organ transplant recipients: a systematic review

“…This end point is of particular interest for agents that modulate the innate immune response as the principal mechanism of action. Concerns about transplant safety have been raised by a case report of a kidney transplant recipient who developed acute tubular necrosis following topical imiquimod treatment . In our analysis, two studies evaluated imiquimod 5% cream applied three times per week.…”