Chronic Inflammatory Demyelinating Polyneuropathy Associated with Sirolimus in a Kidney Transplant Recipient

To present a rare but clinically important case of chronic inflammatory demyelinating polyneuropathy (CIDP) in a kidney transplant recipient on sirolimus-based immunosuppression. Although sirolimus is considered safer in terms of neurotoxicity compared to calcineurin inhibitors, this case highlights its potential for rare but severe neurological adverse effects. A 52-year-old female with stage 5 chronic kidney disease secondary to glomerulonephritis underwent a kidney transplant in 2018. She was maintained on tacrolimus, mycophenolate mofetil, and corticosteroids. In 2022, tacrolimus was reduced due to nephrotoxicity. In 2024, due to gastrointestinal side effects, mycophenolate was briefly replaced with azathioprine, which caused bone marrow suppression. Mycophenolate was restarted, and sirolimus was added. Four months into sirolimus therapy, the patient developed progressive sensory disturbances and lower limb weakness. Electrophysiological studies revealed distal symmetric sensory and motor axonal polyneuropathy. After discontinuation of sirolimus and initiation of corticosteroids, significant neurological improvement was observed. This case supports growing evidence that sirolimus can induce CIDP-like syndromes in transplant recipients. Early identification and prompt withdrawal of the offending agent can lead to symptom resolution and favorable long-term outcomes.