Disclosures: Steven Siano, MD: No financial relationships or conflicts of interest

Case Diagnosis: Mycophenolic acid induced peripheral neuropathy.

Case Description or Program Description: A 27-year-old patient with past medical history of systemic lupus erythematosus (SLE) involving multiple systems was admitted to inpatient rehabilitation unit following SLE induced polyneuropathy. Initial presentation was with bilateral foot weakness 3 weeks prior. The patient was transitioned to mycophenolic acid for her immunosuppressive regimen by her primary rheumatologist while inpatient and abruptly began experiencing burning sensation in the plantar surface of her feet. This patient’s pain was progressive and intolerable, refractory to all medications trialed including topicals and neuropathic agents. In discussion with primary rheumatologist she was transitioned off the mycophenolic acid with resolution of her pain within three days. Patient had continued functional improvement and was able to successfully complete her course of therapy and discharge home.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: The patient had complete resolution of her pain after removal of the medication and continued progress with therapy.

Discussion (relevance): Mycophenolic acid induced peripheral neuropathy is a rare side-effect which has only been documented in one other case study. This condition should be considered in new-onset or worsening of existing neuropathy symptoms in those on this medicaiton. This case was complicated by the patient’s SLE induced peripheral neuropathy, which was previously not painful and only associated with weakness. While paresthesias can be associated with nerve recovery, the quick resolution of her symptoms following removal of the medication was suggestive this medication was the inciting reason.

Conclusions: Mycophenolic acid is a rare, but possible, cause of peripheral neuropathy and should be considered in patients who develop pain or weakness following its administration.

Level of Evidence: Level IV

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