Objective: To report the case of a patient diagnosed with membranous glomerulonephritis and autoimmune non-central neutropenia under treatment with cyclosporin who developed severe, disabling headache.
Case report: A 66-year-old female patient with no history of headache or adverse drug reactions was diagnosed with membranous glomerulonephritis and autoimmune non-central neutropenia. Neoral (cyclosporin A) was initiated at a dose of 2.5 mg/kg/24 h (100 mg/12 h), with whole blood cyclosporin levels within the therapeutic range. After 5 days the patient reported holocranial severe, disabling headache. A cranial CT scan was normal and other headache causes were also ruled out; her headache subsided only upon cyclosporin discontinuation.
Comment: Severe headache is an uncommon adverse effect of cyclosporin whose recognition is relevant, since it may compromise therapy compliance and require the drug to be discontinued. The attribution of cyclosporin with this neurotoxic effect was analyzed using Naranjo's probability estimation method for adverse drug reactions, which resulted in causality being considered probable.