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Bone Pain in Transplant Recipients Responsive to Calcium Channel Blockers

V. Joyce Gauthier, MD, PhD; and Leyka M. Barbosa, MD
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From the University of Washington, Seattle, Washington. Requests for Reprints: V. Joyce Gauthier, MD, PhD, Department of Medicine, RG-28, University of Washington, Seattle, WA 98195. Acknowledgments: The authors thank Drs. Connie Davis and Ganesh Raghu, the other members of the Transplant Services, and Dr. Jeffrey Carlin for referring their patients for evaluation; and Sandrine Graulich, Sylvain Thiebaut, and Drs. Nancy Karr, Maria Alaves, Mart Mannik, Peter Simkin, and Michael L. Richardson for their assistance and insights. Grant Support: In part by grants R29-DK43050 from the National Institute of Diabetes and Digestive and Kidney Diseases and T32-AR07108 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(11):863-865. doi:10.7326/0003-4819-121-11-199412010-00007
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Bouteiller and colleagues [1] and Lucas and colleagues [2] have reported a bone pain syndrome in the epiphyseal regions of 17% of patients who received renal transplantation. This syndrome occurred only in patients receiving cyclosporine in addition to corticosteroids and not in patients treated only with azathioprine and prednisone alone [23]. The episodes of pain were temporally related to increased cyclosporine levels, were relieved when the dose was decreased, and returned with rechallenge [12]. Although multiple toxicities have been attributed to the vasoconstrictive properties of cyclosporine [4], the pathophysiology of these patients' bone pain syndrome remains unknown.

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Figure 1.
Coronal spin-echo magnetic resonance image (TR = 500 ms, TE = 10 ms) of the distal femurs of patient 3 taken 4 months after the first episodes of bilateral knee pain.

Although the first episodes of bone pain in this patient were treated with nifedipine, repeated episodes occurring over the succeeding months were untreated. Bilateral foci of osteonecrosis are noted in the metaphyses of each femur. Similar areas of osteonecrosis were seen in the proximal left femur.

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