Achalasia in a Patient Undergoing Hematologic Stem Cell Transplant After Exposure to Tacrolimus

Sencer Goklemez; Lauren M. Curtis, MD; Alao Hawwa, MD; Alexander Ling, MD; Daniele Avila, CRNP; Theo Heller, MD; Steven Z. Pavletic, MD

Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Sep 2017)

Achalasia in a Patient Undergoing Hematologic Stem Cell Transplant After Exposure to Tacrolimus

Sencer Goklemez,
Lauren M. Curtis, MD,
Alao Hawwa, MD,
Alexander Ling, MD,
Daniele Avila, CRNP,
Theo Heller, MD,
Steven Z. Pavletic, MD

Affiliations

Sencer Goklemez: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
Lauren M. Curtis, MD: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
Alao Hawwa, MD: Translational Hepatology Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
Alexander Ling, MD: Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
Daniele Avila, CRNP: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
Theo Heller, MD: Translational Hepatology Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
Steven Z. Pavletic, MD: Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Correspondence: Address to Steven Z. Pavletic, MD, 10 Center Dr, Bethesda, MD 20892.

Journal volume & issue: Vol. 1, no. 2
pp. 198 – 201

Abstract

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Calcineurin inhibitors (CNIs) are effective agents used for prevention of graft-vs-host disease after allogeneic hematopoietic stem cell transplant or for organ rejection in solid-organ transplant. However, CNIs have a wide range of adverse effects that may necessitate changing to another CNI or immunosuppressive agent. We report a case of acute myeloid leukemia in which achalasia developed after exposure to tacrolimus, as revealed by esophagram results. The patient's symptoms and signs were ameliorated after a change to cyclosporine. This case is the first in the literature to reveal achalasia associated with tacrolimus. Achalasia should be part of a differential diagnosis of upper gastrointestinal symptoms in patients undergoing transplant, and changing to another CNI may be a useful therapeutic intervention.

Published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes

ISSN: 2542-4548 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General)
Website: https://www.journals.elsevier.com/mayo-clinic-proceedings-innovations-quality-and-outcomes/

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