tacrolimus and Alagille-Syndrome

Bullous scabies is an uncommon subtype of scabies that frequently mimics other blistering skin diseases. Nocturnal pruritus is a hallmark symptom of bullous scabies. We report an unusual case of bullous scabies presenting in the absence of pruritus in an immunosuppressed pediatric patient. It is critical that clinicians consider the diagnosis of bullous scabies in any patient with bullae, irrespective of pruritus symptoms.

Topics: Adolescent; Alagille Syndrome; Diagnosis, Differential; Exanthema; Follow-Up Studies; Humans; Immunocompromised Host; Ivermectin; Liver Transplantation; Male; Pemphigoid, Bullous; Pruritus; Risk Assessment; Scabies; Tacrolimus

Topics: Alagille Syndrome; Choroidal Neovascularization; Corneal Dystrophies, Hereditary; Female; Humans; Kidney Failure, Chronic; Liver Transplantation; Night Blindness; Photoreceptor Cells, Vertebrate; Renal Dialysis; Retinal Pigment Epithelium; Tacrolimus; Tomography, Optical Coherence; Vitamin A; Vitamin D; Young Adult

Tacrolimus is prescribed to prevent allograft rejection in pediatric liver transplant recipients; however, its metabolism through the cytochrome P-450 enzyme system presents a multitude of challenges in regard to drug interactions. Here, we describe four children (ages 1.4-8.7 yr) who acutely developed supra-therapeutic serum tacrolimus trough concentrations, despite standard dosing, while on concomitant nicardipine therapy following liver transplantation. Even though tacrolimus regimens were altered (dosage reductions and held doses), serum tacrolimus concentrations remained elevated. Resolution of high tacrolimus concentrations was achieved only after the discontinuation of nicardipine. Following the termination of nicardipine, all children eventually required dosage increases in their tacrolimus regimens to re-achieve target serum concentrations. We conclude that concomitant use of tacrolimus and nicardipine can result in high tacrolimus concentrations due to the inhibition of cytochrome p450 enzymes responsible for the metabolism of tacrolimus. We encourage clinicians to consider alternative antihypertensive options in children on tacrolimus therapy. If nicardipine therapy is necessary, we recommend a 50% reduction in tacrolimus dose and daily serum concentration monitoring.

Topics: Alagille Syndrome; Antihypertensive Agents; Biliary Atresia; Carcinoma, Hepatocellular; Child; Child, Preschool; Cholestasis, Intrahepatic; Cytochrome P-450 Enzyme System; Drug Administration Schedule; Drug Interactions; Drug Monitoring; Female; Graft Rejection; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Infant; Liver Neoplasms; Liver Transplantation; Male; Nicardipine; Reoperation; Tacrolimus

Topics: Adolescent; Alagille Syndrome; Diabetes Mellitus; Humans; Immunosuppressive Agents; Islets of Langerhans; Liver Transplantation; Male; Tacrolimus

Topics: Administration, Oral; Alagille Syndrome; Child, Preschool; Cyclosporine; Dosage Forms; Graft Rejection; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Methylprednisolone; Recurrence; Tacrolimus; Time Factors