Case Report: Imaging Features in a Renal Transplant Patient with Calcineurin Inhibitor-induced Pain Syndrome (CIPS)

Overview

Journal Skeletal Radiol

Specialties Orthopedics
Radiology

Date 2013 Apr 26

PMID 23615775

Citations 4

Authors

Russell W Chapin

Elizabeth Chua

Jennifer Simmons

Martin Bunke

Affiliations

Soon will be listed here.

Abstract

Post-transplant distal limb bone marrow edema syndrome or calcineurin inhibitor-induced pain syndrome (CIPS) is generally a self-limiting but debilitating acute pain syndrome that has been reported in 2-14 % of renal transplant recipients. The disease is extensively described in the transplant literature in patients receiving the calcineurin inhibitors cyclosporine and tacrolimus. We present a case of CIPS arising in a patient 73 days after renal allograft, review the imaging findings, and discuss proposed etiologies and differential diagnoses. To the authors' knowledge, CIPS has not been characterized as a distinct entity in the radiology literature.

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References

Tillmann F, Jager M, Blondin D, Schooldermann D, Voiculescu A, Sucker C . Intravenous iloprost: a new therapeutic option for patients with post-transplant distal limb syndrome (PTDLS). Am J Transplant. 2007; 7(3):667-71. DOI: 10.1111/j.1600-6143.2007.01662.x. View

Collini A, De Bartolomeis C, Barni R, Ruggieri G, Bernini M, Carmellini M . Calcineurin-inhibitor induced pain syndrome after organ transplantation. Kidney Int. 2006; 70(7):1367-70. DOI: 10.1038/sj.ki.5001833. View

Hetzel G, Malms J, May P, Heering P, Voiculescu A, Modder U . Post-transplant distal-limb bone-marrow oedema: MR imaging and therapeutic considerations. Nephrol Dial Transplant. 2000; 15(11):1859-64. DOI: 10.1093/ndt/15.11.1859. View

Franco M, Blaimont A, Albano L, Bendini C, Cassuto E, Jaeger P . Tacrolimus pain syndrome in renal transplant patients: report of two cases. Joint Bone Spine. 2004; 71(2):157-9. DOI: 10.1016/S1297-319X(03)00095-2. View

Breitenstein A, Stumpe K, Gnannt R, Fehr T, Etter C . Calcineurin inhibitor-induced pain syndrome after kidney transplantation-a rare but disabling condition. NDT Plus. 2015; 4(1):63-6. PMC: 4421624. DOI: 10.1093/ndtplus/sfq172. View

Lecouvet F, van de Berg B, Maldague B, Lebon C, Jamart J, Saleh M . Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging. AJR Am J Roentgenol. 1998; 170(1):71-7. DOI: 10.2214/ajr.170.1.9423603. View

Hayes C, Conway W, Daniel W . MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 1993; 13(5):1001-11; discussion 1012. DOI: 10.1148/radiographics.13.5.8210586. View

Goffin E, Vande Berg B, Pirson Y, Malghem J, Maldague B, Van Ypersele De Strihou C . Epiphyseal impaction as a cause of severe osteoarticular pain of lower limbs after renal transplantation. Kidney Int. 1993; 44(1):98-106. DOI: 10.1038/ki.1993.218. View

Elder G . From marrow oedema to osteonecrosis: common paths in the development of post-transplant bone pain. Nephrology (Carlton). 2007; 11(6):560-7. DOI: 10.1111/j.1440-1797.2006.00708.x. View

10.

Kopecky K, Braunstein E, Brandt K, Filo R, Leapman S, Capello W . Apparent avascular necrosis of the hip: appearance and spontaneous resolution of MR findings in renal allograft recipients. Radiology. 1991; 179(2):523-7. DOI: 10.1148/radiology.179.2.2014304. View

11.

Stevens J, Hilson A, Sweny P . Post-renal transplant distal limb bone pain. An under-recognized complication of transplantation distinct from avascular necrosis of bone?. Transplantation. 1995; 60(3):305-7. DOI: 10.1097/00007890-199508000-00018. View

12.

Grotz W, Breitenfeldt M, Braune S, Allmann K, Krause T, Rump J . Calcineurin-inhibitor induced pain syndrome (CIPS): a severe disabling complication after organ transplantation. Transpl Int. 2001; 14(1):16-23. DOI: 10.1007/s001470000285. View

13.

Bouteiller G, Lloveras J, Condouret J, Durroux R, Durand D . [Painful polyarticular syndrome probably induced by cyclosporin in three patients with a kidney transplant and one with a heart transplant]. Rev Rhum Mal Osteoartic. 1989; 56(11):753-5. View

14.

Lucas V, Ponge T, Glemain P, Hourmant M, Soulillou J . Musculoskeletal pain in renal-transplant recipients. N Engl J Med. 1991; 325(20):1449-50. DOI: 10.1056/NEJM199111143252016. View

15.

Korompilias A, Karantanas A, Lykissas M, Beris A . Bone marrow edema syndrome. Skeletal Radiol. 2008; 38(5):425-36. DOI: 10.1007/s00256-008-0529-1. View

16.

Vande Berg B, Malghem J, Goffin E, Duprez T, Maldague B . Transient epiphyseal lesions in renal transplant recipients: presumed insufficiency stress fractures. Radiology. 1994; 191(2):403-7. DOI: 10.1148/radiology.191.2.8153313. View

17.

Gurin L, Gohh R, Evangelista P . Pain syndrome with stress fractures in transplanted patients treated with calcineurin inhibitors. Clin Kidney J. 2015; 5(1):13-6. PMC: 4400457. DOI: 10.1093/ndtplus/sfr156. View

18.

Graif M, Schweitzer M, Marks B, Matteucci T, Mandel S . Synovial effusion in reflex sympathetic dystrophy: an additional sign for diagnosis and staging. Skeletal Radiol. 1998; 27(5):262-5. DOI: 10.1007/s002560050378. View

19.

Garcia-Garcia G, Harden P, Chapman J . The global role of kidney transplantation. Nephrology (Carlton). 2012; 17(3):199-203. DOI: 10.1111/j.1440-1797.2012.01564.x. View