Endoscopic Botulinum Toxin Injection for Tacrolimus-Induced Achalasia in a Renal Transplant Recipient

Post-transplantation achalasia secondary to immunosuppression is a rare complication. Here we present a man who developed dysphagia 4 days after his renal transplant and was found to have achalasia thought to be due to his tacrolimus. Switching from one calcineurin inhibitor to another was not possible in our patient due to the high risk of inducing rejection; thus he was successfully treated with the botulinum injection. To our knoledge, this is the first case of tacrolimus-induced achalasia ever reported in a renal transplant patient; it is also the first case in a transplant patient to be treated endoscopically with botulinum injection.