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• W1988655406 abstract "Cyclosporine (CyA) is a useful immunosuppressive agent for transplantation and aplastic anemia. Its known major side effects are renal damage, hepatic damage including elevation of serum bilirubin, electrolyte disturbance, and gingival swelling. We recently studied 2 patients treated with CyA for different diseases who developed peripheral entrapment neuropathy of the hands, one with the carpal tunnel syndrome and the other with the ulnar (Guyon) tunnel syndrome. Case 1 was a 62-year-old female who had moderate aplastic anemia. She was treated with methylprednisolone followed by oral CyA at a dose of 3 mg/kg twice a day beginning in November 1996. In April 1997, she began to complain of numbness in her left hand that gradually increased in spite of vitamin B12 therapy. Examination of nerve conduction by electromyography (EMG) showed a severe decrease in compound muscle action potential (CMAP; 1.13 mV), sensory nerve conduction velocity (SCV; 40 m/s), and sensory nerve action potential (SNAP; 7.9 µV) in her left median nerve region. The normal ranges of these values are above 8 mV, 50 m/s, and 25 µV, respectively. A diagnosis of carpal tunnel syndrome was made, and surgery was performed in June, 1997. Case 2 was a 46-year-old male with acute myeloid leukemia (M6). He was treated with allogeneic bone marrow transplantation in June 1996. After bone marrow transplantation, CyA was started at a dose of 3 mg/kg/day i.v. After day 60, CyA was administered orally (3 mg/kg twice a day), but because of chronic graft versus host disease, CyA dose reduction could not be carried out according to schedule. In December 1996, the patient began to complain of numbness and neuralgia in his left hand. EMG revealed a marked reduction of CMAP (2.36 mV), SCV (not detectable), and SNAP (not detectable) in his left ulnar nerve region. A diagnosis of ulnar (Guyon) tunnel syndrome was made, and surgery was performed in June 1997. Neither patient showed a deterioration of renal or liver function, and there were no increases in serum β2-microglobulin or amyloid A protein. Serum CyA concentrations were maintained under 200 ng/ml which was thought to be not toxic to renal function, and neither patient took any drugs affecting the metabolism of CyA. Risk factors for entrapment neuropathy include renal damage, collagen disease, amyloidosis, and multiple myeloma [1], but neither of these 2 patients had any history of these factors. CyA is reported to be a cause of nervous system toxicity in the form of epilepsy, tremor, visual hallucinations [2, 3]and peripheral neuropathy [4]. These reports indicate an interaction between CyA and the nervous system. The interaction between CyA and entrapment neuropathy remains unknown, but in view of the fact that the 2 patients described above developed numbness after 6 months of CyA administration, CyA may have some effect on the peripheral nerves and may be able to induce this unusual manifestation." @default.
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• W1988655406 date "1998-01-01" @default.
• W1988655406 modified "2023-10-06" @default.
• W1988655406 title "Cyclosporine and Entrapment Neuropathy" @default.
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• W1988655406 doi "https://doi.org/10.1159/000040893" @default.
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