Reflex sympathetic dystrophy syndrome of the lower limbs in a renal transplant patient treated with tacrolimus

Background. Recently, a previously unrecognized posttransplant syndrome kno wn as reflex sympathetic dystrophy syndrome of the lower limbs has emerged in patients receiving cyclosporine as immunosuppression. We describe herein this complication observed in a patient treated with tacrolimus after kidn ey transplantation. Methods. A 49-year-old man received a kidney transplant from a cadaver dono r and was treated with tacrolimus. Three months later, the patient complain ed of severe pain in the lower limbs that affected both knees and ankles. B one scintigraphy and magnetic resonance were consistent with reflex sympath etic dystrophy syndrome. Results. Laboratory tests that included creatinine, glomerular filtration r ate, calcium, phosphate, urate, alkaline phosphatase, and parathormone were normal or near normal. Tacrolimus levels were around 13 mu g/ml. Clinical improvement appeared slowly and spontaneously during the following 3 months , without appreciable changes in the tacrolimus level. Conclusions. In kidney transplant patients, tacrolimus could be a risk fact or for the development of a reflex sympathetic dystrophy syndrome.