Snapshot A 40-year-old woman presents to the emergency department with worsening lower extremity weakness and decreased visual acuity of the right eye. She reports that her symptoms progressively worsened over the course of a week and after developing a urinary tract infection. Medical history is significant for multiple sclerosis treated with rituximab. Physical examination is significant for 1/5 strength in the lower extremities and an afferent pupillary defect appreciated in the right eye. Magnetic resonance imaging of the brain and spine shows new hyperintense lesions. She is started on intravenous methylprednisolone. Immunosuppressants ImmunosuppressantsMedicationClinical UseMechanism of ActionAdverse EffectsCyclosporineRheumatoid arthritisPsoriasisTransplant rejection prophylaxisCalcineurin inhibitor impairsIL-2 production and releaseIL-2-induced T-cell activationNephrotoxicityNeurotoxicityHirsutismGingival hyperplasiaHypertensionHyperlipidemiaTacrolimus (FK506)Transplant rejection prophylaxisCalcineurin inhibitor via binding with intracellularFKBP-12protein which impairsIL-2 production and releaseIL-2-induced T-cell activationNephrotoxicityNeurotoxicity↑ risk of diabetesSirolimus (Rapamycin)LymphangioleiomyomatosisRenal transplantation prophylaxismTOR inhibitor via binding with intracellularFKBP-12 protein which↓ cytokine-induced T-cell proliferationPancytopeniaHyperlipidemiaEdemaInsulin resistanceBasiliximabRenal transplantation prophylaxisTargets the α-chain of the IL-2 receptor complex which is expressed on activated T-cellsEdemaTremorHypertensionAzathioprineRheumatoid arthritisRenal transplantationInflammatory bowel diseaseAprecursor of 6-mecaptopurine whichincorporates itself into the cell's DNA and halts replicationPancytopeniaHepatotoxicityMycophenolate mofetilOrgan transplantationLupus nephritisInosine monophosphate dehydrogenase (IMPDH) inhibitor whichimpairs guanosine nucleotide synthesisGastrointestinal upsetPancytopeniaHypertensionHyperglycemiaCorticosteroidsA number of autoimmune and inflammatory disordersNF-κB inhibitorInduces T-cell apoptosisHyperglycemiaOsteoporosisCushing syndromeAdrenocortical atrophyPeptic ulcersCataractsAvascular necrosisPsychosis