V Vi Pham1, Dirk O Stichtenoth, Jürgen Borlak. 1. Institute of Clinical Pharmacology, Medizinische Hochschule Hannover and Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany.
Abstract
AIMS: A 23-year-old Caucasian woman, with cystic fibrosis, bilateral lung-transplantation and immunosuppressive therapy with prednisolone, tacrolimus and sirolimus, presented with clinical symptoms of a chronic transplant rejection. METHODS: Since constant sufficient blood level of tacrolimus and sirolimus had never been achieved, a genetic analysis was carried out to clarify drug metabolism. RESULTS: The genetic analysis for polymorphisms of cytochrome P450 (CYP) 3A4,5,7 revealed no sequence alterations in the CYP 3A4,5,7 gene. Thus, drug intake was scrutinized in detail, disclosing a missing interval between the intake of both immunosuppressive agents. After a correct drug intake the woman's condition ameliorated and the blood levels reached normal range. CONCLUSIONS: This case report highlights the crucial importance of basic medical skills like an accurate and dainty drug anamnesis before high tech approaches were applied.
AIMS: A 23-year-old Caucasian woman, with cystic fibrosis, bilateral lung-transplantation and immunosuppressive therapy with prednisolone, tacrolimus and sirolimus, presented with clinical symptoms of a chronic transplant rejection. METHODS: Since constant sufficient blood level of tacrolimus and sirolimus had never been achieved, a genetic analysis was carried out to clarify drug metabolism. RESULTS: The genetic analysis for polymorphisms of cytochrome P450 (CYP) 3A4,5,7 revealed no sequence alterations in the CYP 3A4,5,7 gene. Thus, drug intake was scrutinized in detail, disclosing a missing interval between the intake of both immunosuppressive agents. After a correct drug intake the woman's condition ameliorated and the blood levels reached normal range. CONCLUSIONS: This case report highlights the crucial importance of basic medical skills like an accurate and dainty drug anamnesis before high tech approaches were applied.
Authors: Michel Mourad; Georges Mourad; Pierre Wallemacq; Valérie Garrigue; Christophe Van Bellingen; Valérie Van Kerckhove; Martine De Meyer; Jacques Malaise; Djamila Chaib Eddour; Dominique Lison; Jean Paul Squifflet; Vincent Haufroid Journal: Transplantation Date: 2005-10-15 Impact factor: 4.939
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