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Unexpected outcome (positive or negative) including adverse drug reactions
Case report
Double trouble: ciclosporin–simvastatin coinduced rhabdomyolysis
  1. Yakeen Hafouda1,
  2. Abhishek Sharma2,
  3. Vincent Li3 and
  4. Paul Devakar Yesudian3
  1. 1 Medicine, Cardiff University School of Medicine, Cardiff, UK
  2. 2 Medicine, Watford General Hospital, Watford, UK
  3. 3 Dermatology, Wrexham Maelor Hospital, Wrexham, UK
  1. Correspondence to Dr Abhishek Sharma; a.sharma5{at}nhs.net

Abstract

A 73-year-old woman presented with an acute exacerbation of her long-standing psoriasis. Ciclosporin was commenced due to the severity of her symptoms resulting in remission within 2 weeks. Full blood count, urea and electrolytes following initiation of treatment were unremarkable, although she complained of muscle aches, which was attributed to her known multiple sclerosis. Three weeks later she was admitted to the hospital with diarrhoea and vomiting. Repeat blood tests revealed raised creatinine (528 μmol/L (normal range (NR) n=45–84 μmol/L)), urea (32.6 mmol/L (NR 2.5–7.8 mmol/L)) and creatine kinase (6792 IU/L (NR 25–200 IU/L)) levels and reduced estimated glomerular filtration rate of 7. A diagnosis of acute kidney injury secondary to rhabdomyolysis was made due to an interaction between ciclosporin and simvastatin, precipitated by the dehydration from gastroenteritis. Haemofiltration was required to stabilise her renal function and she made a complete recovery.

  • drug interactions
  • contraindications and precautions
  • unwanted effects/adverse reactions
  • dermatology

https://doi.org/10.1136/bcr-2018-225971

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    Footnotes

    • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in concept development, design, analysis, writing and revision of the manuscript. This case was identified by PDY who was involved in managing the patient. AS, YH and VL contributed to writing this article. YH and AS performed the relevant literature search.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.