Case 43

Published on 18/02/2015 by admin

Filed under Allergy and Immunology

Last modified 18/02/2015

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CASE 43

Ms. Bell received cardiac transplantation approximately 6 years earlier for a cardiomyopathy that developed after she received chemotherapy (doxorubicin [Adriamycin]) for breast cancer. She has had routine endomyocardial biopsies each year, the last being 1 year ago. At that time the pathologist read the biopsy as normal, with no signs of rejection. The only change in her anti-rejection therapy over the past 2 years was a reduction in the prednisone dose (now 7.5 mg/day) and replacement of cyclosporine (which she had received for nearly 5 years since the time of transplantation) with tacrolimus. You (her son) were told that the advantage of tacrolimus was a slightly improved toxicity profile. You arrived home for a visit this afternoon to find your mother confused and with a droop on the left side of her face/mouth. You immediately call an ambulance and arrange transport to the local hospital.

QUESTIONS FOR GROUP DISCUSSION

RECOMMENDED APPROACH

Implications/Analysis of Clinical History

Ms. Bell received a cardiac transplant 6 years ago, and all the evidence we are provided with indicates that this was a successful graft in that the yearly endomyocardial biopsies have all been normal. In fact, the only change in her anti-rejection therapy has been a reduction in immunosuppressive therapy and change from cyclosporine to tacrolimus, which is slightly less toxic.

Implications/Analysis of Laboratory Investigation

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