FK506(Prograf)-induced diabetes mellitus in a patient after allogenic blood stem cell transplantation: reversibility after normalization of toxic FK serum levels

FK506 (Prograf) is increasingly used as immunosuppressivum. Both temporary hyperglycemia and permanent diabetes mellitus have been reported as side ef fects of this therapy. The mechanism for diabetes induction remains obscure . The clinical importance of this side effect is often underestimated. A 38 -year-old man developed a graft-versus-host-disease 7 months after peripher al allogenic blood stem cell transplantation and was treated first with cyc losporine and thereafter with FK506. After 9 months, the patient was admitt ed to hospital due to "unclear deterioration of health status and pneumonia ". Ketoacidotic precoma diabeticum was diagnosed at admittance. Highly toxi c serum levels of FK506 could be determined. A complete normalization of ca rbohydrate metabolism was seen after lowering these levels. The therapy wit h FK506 can induce acute diabetes mellitus. A complete remission may be see n even in severe cases despite continuation of FK506 therapy. The normaliza tion of FK serum levels is necessary for potential reversibility.