Microsoft Word - NEF497BF

Dr. R. Peces, Servicio de Nefrologia, Hospital Covadonga, Celestino Villamil s/n, E-33006 Oviedo (Spain) Dear Sir, Intravenous methylprednisolone is currently used before transplantation as well as for the treatment of acute rejection episodes. Hypersensitivity to methylprednisolone is extremely rare and the reported cases were mostly in atopic or asthmatic patients [1–7]. Among them, only 2 cases were renal transplant recipients [6, 7]. We report a 49-year-old male with a history of seasonal asthma who underwent cadaveric renal transplant in December 27,1989. Before transplantation he received intravenous azathioprine (100 mg), ceftriaxone (1 g) and methylprednisolone sodium succinate (500 mg). Within 2 min the patient complained of generalized itching and dyspnea, and became pale, cold and diaphoretic. Blood pressure was 80/50 mm Hg. He was cyanotic, and a skin rash and bronchospasm were evident. His condition improved with the administration of intravenous amino-phylline, fluids and oxygen. It was believed that the patient had suffered an anaphylactic reaction to one of the administered drugs. The patient was intubated and transplantation surgery was performed successfully. The following morning he received the routine medication including methylprednisolone sodium succinate (30 mg) intravenously and developed both inspiratory and expiratory wheezes. A diagnosis of bronchospasm disease was made and a regime of inhalating albuterol and a sustained-release theophylline were administered. On the 2nd day after transplant, methylprednisolone sodium succinate was replaced by oral prednisone (30 mg/day) without any adverse effect. He was also receiving cyclo-sporine (300 mg/day). The patient was discharged from hospital on the 9th day after transplantation with good graft function. He was then receiving prednisone (30 mg/day), azathioprine (50 mg/day) and cyclosporine (300 mg/day). His blood cyclosporine levels ranged from 562 to 834 ng/ml using a polyclonal radioimmunoassay kit (Sandoz, Basel, Switzerland). One month after transplant he had an acute rejection episode and intravenous methylprednisolone sodium succinate, 500 mg in 200 ml of 5% glucose, was administered. When he had received 2 ml of the solution, he developed facial itching, shivering and bronchospasm with acute breathlessness. An anaphylactic reaction to methylprednisolone sodium succinate was suspected and the infusion stopped. He responded within 15 min to discontinuation of the solution, intravenous injection of 5 mg dexchlorpheniramine maleate and oxygen. The acute rejection episode was managed successfully with high dose oral prednisone