Tacrolimus as a rare cause of pericardial effusion in a renal transplant recipient

Abstract

Pericardial effusion in a renal transplant recipient represents a diagnostic conundrum with a variety of differential diagnoses. Immunosuppressive medications such as sirolimus have been linked to pericardial effusions in the reported literature. Tacrolimus has been reported to be associated with pleural effusions and ascites. We present a case of a patient with tacrolimus as the likely cause of a recurrent pericardial effusion.

New Approaches to Cardiovascular Disease and Its Management in Kidney Transplant Recipients

“…Other than metabolic derangements, CNIs may be associated with direct cardiac toxicity, including dilated cardiomyopathy, hypertrophic cardiomyopathy, and pericardial effusions, as documented by several case reports and small series 107-112 ; however, because of superior efficacy over alternatives, the CNIs remain part of the first-line immunosuppressive regimen, even among heart transplant recipients. 113…”

“…18,104 Unfortunately, this appears to be more common with tacrolimus-based regimens because of the additional tacrolimus-related effect on pancreatic glucokinase activity and is a significant issue associated with the use of this agent. 105,106 Other than metabolic derangements, CNIs may be associated with direct cardiac toxicity, including dilated cardiomyopathy, hypertrophic cardiomyopathy, and pericardial effusions, as documented by several case reports and small series [107][108][109][110][111][112] ; however, because of superior efficacy over alternatives, the CNIs remain part of the first-line immunosuppressive regimen, even among heart transplant recipients. 113…”

Association of sirolimus with pericardial effusion in renal transplant patient and discussion of potential mechanism

“…It is worth mentioning that tacrolimus may also cause pericardial effusion as recently reported 10. Though tacrolimus and sirolimus bind to the same FK12 protein, the binding sites and downstream pathways are different 11.…”

Tacrolimus Induced Ascites After 10 Years Renal Transplantation

“…5 It is proposed that tacrolimus can cause serosal inflammation that leads to fluid accumulation. [1][2][3][4][5] To the best of our knowledge, there is no report about ascites resulting from long-term tacrolimus treatment. In our patient, we tried all the traditional diagnostic and treatment methods for diagnosis in a patient with ascites.…”

“…Pleural effusion, pericardial effusion, and ascites have been reported to be related with tacrolimus in very few cases. [1][2][3][4] Herein, we report a case of unexplained massive fluid retention with ascites in the late post-transplant period and showed dramatic improvement on conversion to cyclosporine.…”