SEVERE MUSCULOSKELETAL PAIN AFTER CYCLOSPORINE-A TREATMENT IN A PATIENT UNDERGOING ALLOGENEIC BMT

Allogeneic BMT was performed in a 33-year-old man because of CML. Dono r was his HLA-identical brother. GVHD prophylaxis consisted of short-t erm MTX and i.v. CsA. On day 17 cutaneous GVHD grade-III developed and high-dose methyl-prednisone was added. Initial daily dose of CsA was 4 mg/kg i.v. CsA dosage was adapted to maintain blood trough levels be tween 200 and 350 ng/ml. On day 27 the patient developed severe muscul oskeletal pain of knees, legs, feet, hands, shoulders and ellbows. Onl y high-dose opioids and dextropropoxyphen were effective for analgesia . Additional medication besides CsA consisted of parenteral nutrition, steroids and antibiotics for total intestinal decontamination. Clinic al and radiological examinantion revealed no causes for musculoskeleta l pain. Serum levels for lactate-dehydrogenase, aldolase, alkaline-pho sphatase, creatinphosphokinase with isoenzymes, electrolytes including magnesium were within normal ranges. Pain decreased within 4 days aft er switching, from intravenous to oral application. This case indicate s that CsA in high dosage given intravenously combined with steroids c an cause severe musculoskeletal pain as side effect in allogeneic BMT.