sirolimus and Fever-of-Unknown-Origin

A variety of medications may cause drug fever. Drug fevers may persist for days to weeks until diagnosis is considered. The diagnosis of drug fever is confirmed when there is resolution of fever within 3 days after the medication is discontinued. Only rarely do undiagnosed drug fevers persist for over 3 weeks to meet fever of unknown origin (FUO) criteria. FUOs due to drug fever are uncommon, and drug fevers due to immunosuppressive drugs are very rare.. This is a case of a 58-year-old female renal transplant recipient who presented with FUO that remained undiagnosed for over 8 weeks.. We believe this is the first reported case of an FUO due to drug fever from sirolimus in a renal transplant recipient.

Topics: Female; Fever of Unknown Origin; Humans; Kidney Transplantation; Middle Aged; Sirolimus

Prolonged fever of unknown origin together with night sweats in the elderly requires a systematic search for malignant and infectious foci. Here we present a case of fever of unknown origin which ultimately led us to the diagnosis of everolimus-induced fever. After changing the immunosuppressive regime it resolved rapidly.

Topics: Aged; Everolimus; Fever of Unknown Origin; Humans; Iatrogenic Disease; Immunosuppressive Agents; Male; Sirolimus

Everolimus is a proliferation signal-inhibitor recently introduced in heart transplant recipients. To date, little is known about calcineurin inhibitor (CNI)-free immunosuppression using everolimus. This study reports the results of CNI-free immunosuppression using everolimus.. During a continuous 9-month period, 60 heart transplant recipients were enrolled. Reasons for switching to everolimus were side effects associated with prior CNI immunosuppression. All patients underwent standardized switching protocols and completed 6 months of follow-up. Blood was obtained for lipid status, renal function, routine controls, and levels of immunosuppressive agents. Echocardiography and a physical examination were performed on Days 0, 14, 28, and then every 3 months.. After switching to everolimus, most patients recovered from the side effects associated with CNIs. Renal function improved significantly after 6 months (creatinine, 2.1 +/- 0.6 vs 1.5 +/- 0.9 mg/dl, p = 0.001; creatinine clearance, 42.2 +/- 21.6 vs 61.8 +/- 23.4 ml/[min x 1.73 m2], p = 0.018). Arterial hypertension improved after 3 months and remained decreased during the observation period. Tremor, peripheral edema, hirsutism, and gingival hyperplasia markedly improved. Adverse events occurred in 8 patients (13.3%), including interstitial pneumonia (n = 2), skin disorders (n = 2), reactivated hepatitis B (n = 1), and fever of unknown origin (n = 3).. Preliminary data suggest that CNI-free immunosuppression using everolimus is safe, with excellent efficacy in maintenance heart transplant recipients. Arterial hypertension and renal function improved significantly. CNI-induced side effects such as tremor, peripheral edema, hirsutism, and gingival hyperplasia markedly improved in most patients.

Topics: Adult; Aged; Blood Pressure; Everolimus; Female; Fever of Unknown Origin; Follow-Up Studies; Heart Transplantation; Hepatitis B virus; Humans; Immunosuppressive Agents; Kidney; Lipids; Lung Diseases, Interstitial; Male; Middle Aged; Prospective Studies; Sirolimus; Skin Diseases; Time Factors; Virus Activation