SHM Converge Scientific Abstract ePoster Gallery-The Diffuse Pruritic Maculopapular Rash in a Kidney Transplant Patient

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A 78-year-old kidney transplant recipient on sirolimus, azathioprine, and prednisone developed a one-month history of diffuse, intensely pruritic maculopapular rash and hair loss shortly after cyclosporine was stopped and sirolimus was started. Examination showed an erythematous, scaly rash on the face, neck, upper extremities, and back. Initial labs were notable for mild anemia and a low sirolimus level.<br /><br />Because of concern for infection or transplant-related complications, the team ordered viral studies (HSV, CMV, EBV, BK), which were negative except for positive HSV-1 IgG. A skin biopsy demonstrated pustular dermatitis with eosinophils and spongiosis, consistent with a drug reaction. Given the timing of symptom onset after sirolimus initiation, sirolimus was considered the likely cause.<br /><br />Transplant nephrology recommended holding sirolimus, and dermatology advised topical steroids plus a high-dose prednisone taper back to the patient’s home dose. The rash improved significantly after treatment, kidney function remained stable, and the patient was discharged with close follow-up.<br /><br />This case highlights that while sirolimus commonly causes mild rashes, severe diffuse pruritic eruptions can rarely occur and may require drug discontinuation.

Asset Subtitle

Umair A. Khan

Meta Tag

Author List Abu Baker Sheikh, Julia Howard, Umair A. Khan

Category Clinical Vignettes

Concept Sirolimus

Concept Pruritic Maculopapular Rash

Concept Drug-Induced Rash

Concept Cutaneous Adverse Effect

Concept Rash

Distinguished Non-Finalist

Presenter Organization University of New Mexico Hospital

Presenting Author Umair A. Khan

Track Adult

Keywords

kidney transplant

sirolimus

drug rash

pruritic rash

maculopapular eruption

hair loss

skin biopsy

pustular dermatitis

eosinophils

prednisone taper

Sirolimus

Pruritic Maculopapular Rash

Drug-Induced Rash

Cutaneous Adverse Effect

Rash