Reactions Weekly | 2021
Tacrolimus
Abstract
Achalasia: case report A 67-year-old man developed achalasia during treatment with tacrolimus. The man, who had various comorbidities, was admitted with a persistent cough, difficulty in swallowing liquid and solid food, heartburn and retrosternal chest pain from the last 4 weeks. He had undergone orthotopic heart transplantation on 13 February 2008. Since then, he had been receiving treatment with tacrolimus [route and dosage not stated] without any postoperative complications. During the presentation, an upper endoscopy was performed, which showed a spasm of the lower oesophagus, and achalasia was suspected. However, the symptoms were spontaneously resolved. The endomyocardial biopsy did not show any evidence of rejection. His electrocardiogram revealed a sinus rhythm without ST-segment elevations, an esophagogram showed a failure of relaxation of the lower oesophageal sphincter with a diverticulum and a dilated oesophagus with the bird’s beak sign. Thereafter, he underwent a manometry, which revealed peristalsis of the oesophagus with high residual pressure of the lower oesophageal sphincter. Based on these findings and clinical presentation, a diagnosis of tacrolimus induced achalasia was made [duration of treatment to reaction onset not stated]. The man underwent laparoscopic Heller myotomy, and his symptoms of dysphagia were resolved after the procedure. He was recovered and discharged from the hospital. During follow-up, after 8 months of his discharge, he had not developed any other symptoms of dysphagia or recurrence of achalasia.