Usman M, Adil S N, Kakepoto G N, Khurshid M.
Cyclosporin induced fatal rhabdomyolysis in a Young Patient with Acquired Aplastic Anemia: a Case Report.
J Pak Med Assoc Jan ;53(7):312-3.

A sixteen years old male presented to the hematology outpatient with history of fever and increasing pallor since two weeks. On examination, he was grossly pale. Petechial hemorrhages were evident on both legs and feet. Subsequently, a complete blood count, reticulocyte count, bone marrow and trephine were carried out which was consistent with the diagnosis of severe aplastic anemia. Various treatment options were discussed and the patient opted for immunosuppressive therapy. He was given injection anti lymphocyte globulin 10mg/kg daily intravenously for five days and injection methyl prednisolone 2mg/kg intravenously for four days. On fifth day of the treatment, he was started on oral Cyclosporin 5mg/kg daily. After just three doses of cyclosporin, he developed severe pain in both calf muscles. Examination revealed a heart rate of 120 per minute, temperature 38oC and blood pressure 105/65 mm Hg. There was bilateral calf muscles swelling and marked tenderness with a complete functional disability of both lower limbs. Laboratory investigations done at that time revealed creatine phosphokinase 7451i.u. (17-176), serum myoglobin 6150ug/L (upto 70). He was admitted to the hospital. Cyclosporin was stopped. He was started on intravenous fluids along with empiric antibiotics. But his condition deteriorated and was resuscitated and intubated, but could not be revived and expired.

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