Reactions 1680, p314 - 2 Dec 2017 Achalasia: case report A 57-year-old man developed achalasia following treatment with tacrolimus [route not stated]. The man, who had acute myelocytic leukaemia, underwent allogeneic haematopoietic stem cell transplant. Three days prior to the transplantation, he received tacrolimus at a target blood level of 5 to 10 ng/mL and sirolimus for graft-vs-host disease prophylaxis. A day prior to the transplantation, he experienced odynophagia. His laboratory test revealed elevated amylase and lipase levels. An abdominal CT scan showed mild stranding around the pancreas, suggestive of pancreatitis. He received pain medication and fluid resuscitation for suspected pancreatitis. Fifteen days after the transplantation, he began oral intake of pills and solid food; however, he experienced worsening dysphagia. By the nd 22 day of transplantation, he was discharged and his medications were switched to liquid formulations due to th persistent dysphagia. On the 33 days of the transplantation, he was again hospitalised right arm abscess related to a peripherally inserted central catheter line. During hospitalisation, he reported persistent dysphagia and retrosternal discomfort. A barium swallow test findings were consistent with achalasia. The man was treated with pantoprazole and his abdominal and chests pain improved. He started to tolerate small quantities of food and pills and he was discharged.By the th 50 day of the transplantation, his dysphagia again th deteriorated. On the 78 day of transplantation, an oesophageal manometry results were consistent with achalasia. He also experienced severe generalized bone and muscle pain secondary to tacrolimus. To relieve this pain, tacrolimus was switched to cyclosporin. At follow-up on th 140 days of the transplantation, a repeated oesophagram showed improvement in achalasia. However, he continued to experience dysphagia, reflux, upper abdominal pain and poor appetite. At six months follow-up, there was remarkable improvement in his symptoms. A follow-up oesophagram showed complete absence of lower oesophageal sphincter narrowing, with peristaltic coordination, normal passage of contrast materials from oesophagus into stomach and minor dysmotility. Author comment: "Given the temporal relationship of development of an exacerbation of achalasia soon after starting tacrolimus and complete resolution after stopping, we suspect that starting tacrolimus was the most likely inciting cause". Goklemez S, et al. Achalasia in a Patient Undergoing Hematologic Stem Cell Transplant After Exposure to Tacrolimus. Mayo Clinic Proceedings: Innovations, Quality and Outcomes 1: 198-201, No. 2, Sep 2017. Available from: URL: http:// doi.org/10.1016/j.mayocpiqo.2017.06.004 - USA 803284104 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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