Calcium pyrophosphate deposition (CPPD) in a liver transplant patient: are hypomagnesemia, tacrolimus or both guilty? A case-based literature review.
Study Goal
The researchers aimed to investigate the link between persistent hypomagnesemia induced by tacrolimus and calcium pyrophosphate deposition (CPPD) in a liver transplant patient.
Results Summary
The study found that hypomagnesemia caused by tacrolimus led to CPPD, presenting as acute oligoarthritis and low back pain. After switching to everolimus and supplementing magnesium, the patient's symptoms resolved without relapse over 8 months.
Population
A 53-year-old male liver transplant recipient.
Effective Dosage
Not specified
Duration
8 months follow-up
Interactions
Tacrolimus (renal magnesium loss), proton pump inhibitor (potential contributor to hypomagnesemia)
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Persistent hypomagnesemia | increase | Calcium pyrophosphate deposition (CPPD) | - | - | can be induced by | #1 |
Tacrolimus | increase | hypomagnesemia | organ transplant patient | - | potentially inducer of | #2 |
Tacrolimus | increase | renal loss | - | - | induces hypomagnesemia by | #3 |
Magnesium oral supplementation | neutral | - | 53-year-old man, liver transplant 10 months earlier | - | was started | #4 |
Magnesium oral supplementation | no change | no relapse of pain | 53-year-old man, liver transplant 10 months earlier | - | resulted in | #5 |
Calcium pyrophosphate deposition (CPPD) can be induced by a persistent hypomagnesemia. Tacrolimus is an immunosuppressive treatment especially used in organ transplant, potentially inducer of hypomagnesemia by renal loss. A 53-year-old man, liver transplant 10 months earlier, developed an acute peripheral oligoarthritis of wrist, hip and elbow with fever, associated with acute low back pain. Synovial fluid was sterile, and revealed calcium pyrophosphate crystals. Spinal imaging showed inflammatory changes. Magnesium blood level was low at 0.51 mmol/l, with high fractional excretion in favor of renal loss. Tacrolimus was changed for everolimus, proton pump inhibitor was stopped, and magnesium oral supplementation was started. After 8 months follow-up and slow prednisone tapering, he did not relapse pain. Persistent hypomagnesemia is a rare secondary cause of CPPD. In this entity, drug liability should be investigated such as tacrolimus in organ transplant patient.