Reflex sympathetic dystrophy syndrome of the lower limbs in renal transplant patients treated with cyclosporin A

Abstract

In a 36‐month period, 240 patients at our institution received kidney transplants from cadaver donors. Cyclosporin A (CsA) was used as the initial immunosuppressive therapy. Seven patients (5 men and 2 women) developed severe pain, periarticular soft tissue swelling with no effusion, and vasomotor changes in affected areas. Although articular mobility was conserved, most of the patients had great difficulty in walking. A patchy osteoporotic pattern was seen radiographically and increased uptake of 99mtechnetium with a periarticular distribution in the clinically affected areas were found. All of these symptoms and radiographic and scintigraphic signs are compatible with definite reflex sympathetic dystrophy syndrome (RSDS). Articular symptoms began within 3 months after kidney transplantation in all patients; all but 1 patient had plasma CsA levels >200 ng/ml at that time. When the dosage of CsA was reduced, there was concomitant improvement in the RSDS, which appeared when the plasma CsA levels declined to <200 ng/ml. The mean duration of the clinical symptoms of RSDS was 8 months. We believe RSDS should be added to the list of complications that may appear in kidney transplant patients who receive CsA treatment.

Transient Bone Marrow Edema in Renal Transplantation: A Distinct Post‐transplantation Syndrome with a Characteristic MRI Appearance

“…In the original series of patients, only one of the patients described was being treated with concomitant corticosteroid therapy (16). The four patients described in the series of Stevens et al (2) were all treated with a combination of cyclosporin and prednisolone.…”

Leg bone pain syndrome in a kidney transplant patient treated with tacrolimus (FK506)

“…Although the radiographic and bone scintigraphy findings suggested RSDS, the symptoms of this patient were not the classic features of this entity. The efficacy of corticosteroids in the treatment of uncomplicated RSDS has been demonstrated,4 5 so it is possible that corticosteroids might have a protective role against a full RSDS development, as she was treated with high doses of prednisone after the renal transplantation.…”

Pharmacotherapy for Treatment of Complex Regional Pain Syndrome

“…13 There are a plethora of other reported etiologies, including surgery, particularly arthroscopy, 14 myocardial ischemia or stroke/hemiplegia, 15 arteriovenous graft placement for hemodialysis, 16 and even administration of cyclosporine. 17 Interestingly, 1 report showed no inciting event in 35% of the CRPS patients. 10 Among the more popular theories regarding the mechanism of persistent pain and allodynia in CRPS is overproduction of inflammatory mediators and algesic neuropeptides by peripheral nerves.…”