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Case report
peer-reviewed

Sirolimus-Associated Pruritus: Case Report and Review



Abstract

Sirolimus is an immunosuppressant drug used to prevent organ rejection in transplant patients. We describe a man with sirolimus-associated pruritus and review the features of this adverse event in other individuals receiving this drug. The patient was a 67-year-old heart transplant recipient receiving sirolimus as part of his immunosuppressive regimen. He developed severe pruritus over the distal extremities, face, and earlobes six months after starting the drug. The symptoms became progressively worse as he continued to receive this medication. Temporary elimination of the drug resulted in cessation of his itching. Subsequently, sirolimus was discontinued and everolimus was started; this provided temporary relief of his pruritus. PubMed was used to review the following terms: “sirolimus”, “itch”, and “pruritus.” Relevant papers and their references were reviewed. We are aware of only one other patient in whom pruritus necessitated cessation of treatment with sirolimus. Systemic pruritus is a rare adverse event associated with sirolimus. It can occur in both heart and liver transplant patients, beginning several months after transplant, and typically persists. Dose reduction may improve symptoms. Discontinuation of the medication or use of alternative immunosuppressants may be necessary for complete symptom relief.



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Case report
peer-reviewed

Sirolimus-Associated Pruritus: Case Report and Review


Author Information

Joyce Y. Cheng Corresponding Author

Department of Internal Medicine, University of California, San Diego

Philip R. Cohen

Department of Dermatology, University of California, San Diego


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


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Case report
peer-reviewed

Sirolimus-Associated Pruritus: Case Report and Review

Joyce Y. Cheng">Joyce Y. Cheng , Philip R. Cohen">Philip R. Cohen

  • Author Information
    Joyce Y. Cheng Corresponding Author

    Department of Internal Medicine, University of California, San Diego

    Philip R. Cohen

    Department of Dermatology, University of California, San Diego


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: June 27, 2017

    DOI

    10.7759/cureus.1398

    Cite this article as:

    Cheng J Y, Cohen P R (June 27, 2017) Sirolimus-Associated Pruritus: Case Report and Review. Cureus 9(6): e1398. doi:10.7759/cureus.1398

    Publication history

    Received by Cureus: June 13, 2017
    Peer review began: June 21, 2017
    Peer review concluded: June 21, 2017
    Published: June 27, 2017

    Copyright

    © Copyright 2017
    Cheng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Sirolimus is an immunosuppressant drug used to prevent organ rejection in transplant patients. We describe a man with sirolimus-associated pruritus and review the features of this adverse event in other individuals receiving this drug. The patient was a 67-year-old heart transplant recipient receiving sirolimus as part of his immunosuppressive regimen. He developed severe pruritus over the distal extremities, face, and earlobes six months after starting the drug. The symptoms became progressively worse as he continued to receive this medication. Temporary elimination of the drug resulted in cessation of his itching. Subsequently, sirolimus was discontinued and everolimus was started; this provided temporary relief of his pruritus. PubMed was used to review the following terms: “sirolimus”, “itch”, and “pruritus.” Relevant papers and their references were reviewed. We are aware of only one other patient in whom pruritus necessitated cessation of treatment with sirolimus. Systemic pruritus is a rare adverse event associated with sirolimus. It can occur in both heart and liver transplant patients, beginning several months after transplant, and typically persists. Dose reduction may improve symptoms. Discontinuation of the medication or use of alternative immunosuppressants may be necessary for complete symptom relief.



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Joyce Y. Cheng, M.D., Resident Physician, M.H.S.

Department of Internal Medicine, University of California, San Diego

For correspondence:
cheng.joyce.y@gmail.com

Philip R. Cohen, M.D., Professor

Department of Dermatology, University of California, San Diego

Joyce Y. Cheng, M.D., Resident Physician, M.H.S.

Department of Internal Medicine, University of California, San Diego

For correspondence:
cheng.joyce.y@gmail.com

Philip R. Cohen, M.D., Professor

Department of Dermatology, University of California, San Diego