Calcineurin inhibitor-induced irreversible neuropathic pain after allogeneic hematopoietic stem cell transplantation

The calcineurin inhibitors (Cls) cyclosporine A and tacrolimus are essential for graft-versus-host disease prophylaxis but are associated with adverse effects, including neurotoxicity We report a case of irreversible Cl-induced neuropathic pain following allogeneic hematopoietic stem cell transplantation. The patient developed dysesthesia, electric shock-like pain. and severe itching followed by intractable analgesic-resistant pain in the lower extremities. There were no abnormal radiographic findings, and there was no improvement with a reduction of Cl dosage or with administration of a calcium channel blocker. These clinical findings are similar to but inconsistent with Cl-induced musculoskeletal pain syndromes previously reported in organ transplantation.