Este é um caso de uma mulher solteira de 26 anos, asiática (Bhutanesa), que pesa 44 kg e tem 163 cm de altura, admitida na ala de medicina por náuseas, vómitos, dor abdominal, gastrite crónica, anemia, hipertensão, falta de apetite e níveis elevados de ureia e creatinina no sangue. O caso foi reportado ao Centro de Farmacovigilância a 16 de Novembro de 2020 como uma reação adversa ao medicamento. A paciente foi submetida a um transplante renal em 2013 e a um segundo transplante em 2015. Desde então, tem tomado medicação oral anti-rejeição e anti-hipertensiva, incluindo tacrolimus (Tacrograf) 2 mg duas vezes por dia, prednisolona 5 mg uma vez por dia, leflunomida 20 mg uma vez por dia, nifedipina 40 mg duas vezes por dia e hidralazina 50 mg três vezes por dia. Na noite de 6 de Novembro de 2020, a paciente apresentou náuseas, vómitos e dor abdominal intensa e foi transportada para a ala de emergência, onde o exame físico não foi notável, sem febre mas com um abdómen sensível. Os sinais vitais foram os seguintes: pressão arterial (BP) 152/94 mm/Hg, pontuação de dor visual 3/10, taxa respiratória 18 respirações por minuto; taxa de pulso 86 batimentos por minuto; saturação parcial de oxigénio (SpO2) 96%; e temperatura corporal 96 °F. Os resultados laboratoriais foram os seguintes: hemoglobina (Hb) 7.7 g/dl (11.3-14.9 g/dl); contagem de glóbulos vermelhos (RBC) 3.3 × 106/μl (3.76–4.84 × 106/μl); hematócrito (Hct) 24.7% (33–45%), contagem de glóbulos brancos (WBC) 21.4 × 103/μl (4–10 × 103/μl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45%), e temperatura corporal 96 °F. Os resultados laboratoriais foram os seguintes: hemoglobina (Hb) 7.7 g/dl (11.3-14.9 g/dl); contagem de glóbulos vermelhos (RBC) 3.3 × 106/μl (3.76–4.84 × 106/μl); hematócrito (Hct) 24.7% (33–45%), contagem de glóbulos brancos (WBC) 21.4 × 103/μl (4–10 × 103/μl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl), e ureia (Ur) 200 mg/dl (15–45 mg/dl); creatinina sérica (Cr) 8.6 mg/dl (0.6–1.2 mg/dl),