{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:10:08Z","timestamp":1756365008162,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,1,12]]},"abstract":"<jats:p>An infant boy with steroid-resistant nephrotic syndrome (idiopathic membranous glomerulonephropathy) achieved remission with ciclosporin but developed eosinophilia and high IgE levels (max 19\u2005000 \u2005iU\/mL). Conversion to tacrolimus resulted in chronic diarrhoea (eosinophilic gastroenteritis), muscle weakness, polyserositis and failure-to-thrive. In contrast, a trial without tacrolimus resulted in a ciclosporin-responsive relapse, therapy-resistant focal seizures with generalised spikes, worsening muscle weakness and diarrhoea. The patient was weaned off of ciclosporin and completely normalised. In vitro testing demonstrated decreased viability of the patient's cells when incubated with calcineurin inhibitors (ciclosporin, 70%; tacrolimus, 80% compared to control cells), supporting their role in this adverse drug reaction.<\/jats:p>","DOI":"10.1136\/bcr-2016-218496","type":"journal-article","created":{"date-parts":[[2017,1,30]],"date-time":"2017-01-30T10:30:43Z","timestamp":1485772243000},"page":"bcr2016218496","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Idiosyncratic drug reactions and membranous glomerulopathy"],"prefix":"10.1136","volume":"2017","author":[{"given":"Amrit","family":"Kirpalani","sequence":"first","affiliation":[{"name":"Department of Paediatrics, University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J","family":"Rieder","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin C","family":"Bax","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Filler","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,1,30]]},"reference":[{"key":"2025082723390474000_2017.jan30_1.bcr2016218496.1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s00467-013-2717-z","article-title":"Membranous nephropathy: not just a disease for adults","volume":"30","author":"Ayalon","year":"2015","journal-title":"Pediatr Nephrol"},{"key":"2025082723390474000_2017.jan30_1.bcr2016218496.2","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1111\/bcp.12505","article-title":"In vitro testing for diagnosis of idiosyncratic adverse drug reactions: implications for pathophysiology","volume":"80","author":"Elzagallaai","year":"2015","journal-title":"Br J Clin Pharmacol"},{"key":"2025082723390474000_2017.jan30_1.bcr2016218496.3","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/petr.12051","article-title":"Long-term follow-up of de novo allergy in pediatric liver transplantation\u201410 yr experience of a single center","volume":"17","author":"Lee","year":"2013","journal-title":"Pediatr Transplant"},{"issue":"6","key":"2025082723390474000_2017.jan30_1.bcr2016218496.4","first-page":"vi79","article-title":"Treatment of idiopathic nephrosis by immunophillin modulation","volume":"18","author":"Meyrier","year":"2003","journal-title":"Nephrol Dial Transplant"},{"key":"2025082723390474000_2017.jan30_1.bcr2016218496.5","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1390055"},{"key":"2025082723390474000_2017.jan30_1.bcr2016218496.6","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/230386"},{"key":"2025082723390474000_2017.jan30_1.bcr2016218496.7","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/BF03256387","article-title":"Predictive value of the lymphocyte toxicity assay in the diagnosis of drug hypersensitivity syndrome","volume":"14","author":"Elzagallaai","year":"2010","journal-title":"Mol Diagn Ther"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-218496","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:39:15Z","timestamp":1756363155000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-218496"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,30]]},"references-count":7,"alternative-id":["10.1136\/bcr-2016-218496"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-218496","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2017,1,30]]}}}