Clinical cases Flashcards
(3 cards)
Which medication is most likely responsible for his current symptoms?
A 42-year-old male who underwent a renal transplant 3 months ago comes in for follow-up. He has been stable on triple therapy with cyclosporine, mycophenolate mofetil, and prednisone. Today, he complains of gum swelling, and on physical exam you notice gingival hypertrophy and coarse hair growth on his arms. His BP is 156/94 mmHg.
A) Tacrolimus
B) Cyclosporine
C) Mycophenolate
D) Prednisone
✅ Answer: B) Cyclosporine
Explanation: Cyclosporine is classically associated with gingival hyperplasia, hirsutism, and hypertension. Tacrolimus, in contrast, causes neurotoxicity and diabetes, but not cosmetic changes.
What is the most likely cause of her metabolic disturbance?
A 55-year-old woman underwent a liver transplant two months ago. Her immunosuppressive regimen includes tacrolimus and prednisone. She now presents with polyuria, polydipsia, and a fasting glucose of 168 mg/dL. Her HbA1c is 7.4%.
A) Post-op infection
B) Corticosteroid use
C) Tacrolimus
D) Rejection crisis
✅ Answer: C) Tacrolimus
Explanation: Tacrolimus is known for its diabetogenic effects, often leading to new-onset diabetes after transplantation (NODAT) due to islet cell toxicity and insulin resistance.
What is the most likely next step in management?
A 47-year-old female underwent a kidney transplant and is on tacrolimus, mycophenolate, and low-dose prednisone. She presents with tremor, confusion, and mildly elevated serum creatinine. Vital signs are stable. Her tacrolimus level is 18 ng/mL (target range: 5–15 ng/mL). No fever, leukocytosis, or allograft tenderness is present.
A) Increase prednisone dose to treat rejection
B) Add azathioprine
C) Decrease tacrolimus dose
D) Biopsy the renal graft
✅ Answer: C) Decrease tacrolimus dose
Explanation: The neurologic symptoms (tremor, confusion) and elevated drug level point toward tacrolimus neurotoxicity. Biopsy is unnecessary unless rejection is strongly suspected, and no signs point to it here.
