TY - JOUR T1 - Acute Inflammatory Syndrome with Elevated Procalcitonin Induced by Mycophenolate Sodium JF - The Journal of Rheumatology JO - J Rheumatol SP - 658 LP - 659 DO - 10.3899/jrheum.111083 VL - 39 IS - 3 AU - JAN LOOCK AU - PETER LAMPRECHT AU - WOLFGANG L. GROSS Y1 - 2012/03/01 UR - http://www.jrheum.org/content/39/3/658.abstract N2 - To the Editor:Mycophenolate is one of the mainstays of immunosuppressive therapy after organ transplantation and has also been increasingly used in the treatment of rheumatic diseases1. It is applied either as mycophenolate mofetil (MMF) or its enteric coated formulation (mycophenolate sodium; MPS). The immunosuppressive action of mycophenolate is mainly based on the inhibition of the de novo purine biosynthesis required for the proliferation of T and B lymphocytes2.We describe a 72-year-old man with a 35-year history of seropositive rheumatoid arthritis (RA). During his disease course he had received multiple disease-modifying antirheumatic treatments (DMARD), which were either ineffective (chloroquine, sulfasalazine, gold) or discontinued because of adverse effects or contraindications (methotrexate, leflunomide). In 2007, the course had been complicated by an infected hip replacement with sepsis and secondary aortic valve endocarditis. A steady decline of his renal function (creatinine clearance 20 ml/min) was attributed to systemic amyloidosis. In September 2010, DMARD treatment with azathioprine was switched to MPS because of toxic bone marrow damage. Shortly thereafter, he developed severe migrating pains … Address correspondence to Dr. J. Loock, University of Lübeck, Department of Rheumatology, Vasculitis Center and Klinikum Bad Bramstedt, O.-Alexander-Str. 26, 24576 Bad Bramstedt, Germany. E-mail: loock.rostock{at}freenet.de ER -