Document Detail


Early everolimus-induced pneumonitis in a renal transplant recipient: A case report.
MedLine Citation:
PMID:  23274336     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Everolimus is a derivative of sirolimus, and is considered to be free of the latter's pulmonary toxicity. Recently, a few cases of everolimus-induced lung injury have been reported. Early recognition of drug-induced lung disease is important because it can be reversed if appropriate therapy is instituted soon after the onset of symptoms.
CASE REPORT: We present the case of an everolimus-induced pneumonitis in a renal transplant recipient, which occurred as early as on the 5th day after everolimus introduction. Shortly after the transplant procedure, the patient presented with typical symptoms of pulmonary infection. Chest radiography and computed tomography showed bilateral patchy lung infiltrates with peribronchial distribution that were suggestive of bacterial pneumonia. However, there was no improvement with empiric antibiotic treatment. Repeated cultures from the blood, sputum, and broncho-alveolar lavage (BAL) also were negative. Tuberculosis, Pneumocystis jiroveci, and Cytomegalovirus infections were excluded. A transbronchial lung biopsy performed 9 days after the onset of symptoms revealed mild nonspecific inflammation with a fibrotic component in the bronchial walls. Withdrawal of everolimus on the third day of hospitalization and after 8 days of its usage resulted in quick clinical recovery and resolution of radiological abnormalities within 1 month.
CONCLUSIONS: Diagnosis of drug-induced pulmonary toxicity is difficult because it is essentially a diagnosis of exclusion. Lack of response to empiric antibiotic treatment and an imaging pattern of organizing pneumonia should raise suspicion of everolimus-induced pneumonitis in patients undergoing therapy with this drug.
Authors:
Katarzyna Sułkowska; Piotr Palczewski; Dorota Miszewska-Szyszkowska; Magdalena Durlik; Marek Gołębiowski; Piotr Małkowski
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Annals of transplantation : quarterly of the Polish Transplantation Society     Volume:  17     ISSN:  2329-0358     ISO Abbreviation:  Ann. Transplant.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-05-28     Revised Date:  2013-06-17    
Medline Journal Info:
Nlm Unique ID:  9802544     Medline TA:  Ann Transplant     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  144-8     Citation Subset:  IM    
Affiliation:
1st Department of Clinical Radiology, Medical University of Warsaw, Chałubińskiego 5 St., Warsaw, Poland. kkornatowska@tlen.pl
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MeSH Terms
Descriptor/Qualifier:
Adult
Graft Rejection / prevention & control
Humans
Immunosuppressive Agents / adverse effects*,  therapeutic use
Kidney Failure, Chronic / surgery*
Kidney Transplantation*
Male
Pneumonia / chemically induced*,  diagnosis
Postoperative Complications / chemically induced*,  diagnosis
Sirolimus / adverse effects,  analogs & derivatives*,  therapeutic use
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 159351-69-6/everolimus; 53123-88-9/Sirolimus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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