Rhabdomyolysis as a clinical manifestation of association with ciprofibrate, sirolimus, cyclosporine, and pegylated interferon-α in liver-transplanted patients: a case report and literature review

Transplant Proc. 2014 Jul-Aug;46(6):1887-8. doi: 10.1016/j.transproceed.2014.05.065.

Abstract

Background: Rhabdomyolysis is a syndrome characterized by impaired metabolic integrity of myocytes, causing the release of intracellular constituents into the circulation, and can be a serious side effect of drug intake.

Case report: This report describes a unique case of rabdomyolysis secondary in which ciprofibrate, sirolimus, cyclosporine, and pegylated interferon-α in a liver transplant patient was used. A 47-year-old male liver transplant recipient in 2009, who had hepatitis C and incidental hepatocellular carcinoma, underwent immunosuppressive therapy (cyclosporine and sirolimus). The patient is currently in treatment for viral recurrence with pegylated interferon-α and ribavirin; he had a history of hypertriglyceridemia treated with ciprofibrate. He had development of severe and generalized myalgia and fever after the eighth application of pegylated interferon-α and increasing doses of cyclosporine. Laboratorial tests showed acute renal failure and significant increase in creatine kinase. Rhabdomyolysis secondary to interaction of fibrate-cyclosporine-pegylated interferon-α was postulated.

Conclusions: Medical professionals should be aware of possible drug interactions and should monitor patients receiving these drugs.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antiviral Agents / therapeutic use
  • Cyclosporine / adverse effects*
  • Drug Interactions
  • Drug Therapy, Combination
  • Fibric Acids / adverse effects*
  • Hepatitis C / drug therapy
  • Humans
  • Immunosuppressive Agents
  • Interferon-alpha / adverse effects*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Polyethylene Glycols / therapeutic use
  • Rhabdomyolysis / chemically induced*
  • Ribavirin / therapeutic use
  • Sirolimus / adverse effects*

Substances

  • Antiviral Agents
  • Fibric Acids
  • Immunosuppressive Agents
  • Interferon-alpha
  • Polyethylene Glycols
  • Ribavirin
  • Cyclosporine
  • ciprofibrate
  • Sirolimus