sirolimus and Alveolitis--Extrinsic-Allergic

Novel therapeutic agents are currently being investigated for neuroendocrine tumour treatment.. We report here on the case of a patient presenting with hypersensitivity pneumonitis while being treated with everolimus, a mammalian target of rapamycin (mTOR) inhibitor.. Side effects of everolimus should be familiar to clinicians, including nonspecialists, and be monitored carefully to allow for prompt management.

Topics: Alveolitis, Extrinsic Allergic; Antineoplastic Agents; Everolimus; Humans; Intestine, Small; Liver Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Sirolimus

Topics: Alveolitis, Extrinsic Allergic; Biopsy; Drug Hypersensitivity; Drug-Eluting Stents; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Sirolimus; Steroids; Tomography, X-Ray Computed; Treatment Outcome

The differential diagnosis of pulmonary infiltrates after solid-organ transplantation presents a broad differential diagnosis including opportunistic infections and drug-induced lung disease. We report an adult liver transplant recipient who had breathlessness and pulmonary infiltrates following the introduction of sirolimus, and in whom transbronchial biopsy demonstrated a granulomatous interstitial pneumonitis and an organizing pneumonia with a CD4 T-cell infiltrate suggesting a T-helper cell-associated reaction to a processed sirolimus protein complex. Withdrawal of sirolimus produced a rapid clinical and radiologic improvement. This case indicates that with the increasing use of sirolimus, clinicians need to be aware of pulmonary hypersensitivity from this agent.

Topics: Aged; Alveolitis, Extrinsic Allergic; CD4-Positive T-Lymphocytes; Female; Humans; Immunosuppressive Agents; Liver Transplantation; Pneumonia; Sirolimus