Skin infections are common in immunosuppressed patients, and rare pathogens should be considered. 305 TACROLIMUS TOXICITY FROM NILUTAMIDE CO-ADMINISTRATION: A CASE REPORT A KENNARD, D JOHNSON, C HAWLEY Princess Alexandra Hospital, Brisbane,

QLD, Australia Background: Nilutamide is a nonsteroidal anti-androgen used in metastatic prostate cancer as a second line therapy in patients where androgen ablation has failed. To our knowledge, there is no prior reported drug interaction between nilutamide and tacrolimus, which is a principal immune suppressant employed in anti-rejection regimens in kidney transplantation. Case Report: A 62-year-old Caucasian, male kidney transplant recipient experienced a precipitous decline in renal function from baseline Opaganib cell line creatinine 120 mmol/L to 172 mmol/L 8 days after starting nilutamide. This was accompanied by neurotoxic symptoms of tremor, new onset Epigenetics Compound Library order hyperglycaemia and elevation of trough tacrolimus concentrations from 5.6 to 12.6 μg/L. The man had a past history of kidney transplantation for end-stage renal failure secondary to IgA nephropathy. His immunosuppression regimen consisted of tacrolimus, prednisolone and mycophenolate mofetil. There had been no changes made to his medications

other than the commencement of nilutamide. Following cessation of nilutamide, the man’s renal function returned to baseline and his symptoms resolved within 6 days. No other specific treatment was given. Nilutamide is known inhibitor of P450 2C19, but, like steroid-based drugs, can also inhibit CYP3A4, which is involved in tacrolimus metabolism. Conclusions: After thorough evaluation for alternative causes of acute kidney injury, it is suspected that the episode of acute kidney injury reflects a previously undocumented drug interaction between nilutamide and tacrolimus. More frequent therapeutic monitoring of calcineurin inhibitor levels is recommended for transplant patients

receiving nilutamide therapy. 306 STONES, BONES, ABDOMINAL MOANS AND PARATHYROID’S GROWN K BLAZE, C QUINLAN, A WALKER Royal Children’s Thymidylate synthase Hospital, Melbourne, Victoria, Australia Background: A previously well 16-year-old girl presented with recurrent renal stones despite generous fluid intake and two lithotripsy procedures. Case Report: Despite successful lithotripsy she re-presented within one month post-procedure with painless macroscopic haematuria and repeat imaging consistent with stone recurrence. A metabolic work up revealed a marked hypercalcaemia with an elevated urinary calcium-to-creatinine ratio and hyperparathyroidism. She went on to have a cervical ultrasound suspicious for parathyroid adenoma posterior to the right lower lobe of the thyroid. A Tc 99m sestamibi scan confirmed the diagnosis. Conclusions: This demonstrates a case of primary hyperparathyroidism presenting as recurrent renal stones. Since excision of the parathyroid adenoma 2 years ago, this patient’s serum calcium and PTH have normalised and she has had no further stone recurrence.