Howard Luke, Gopalan Deepa, Griffiths Meryl, Mahadeva Ravi
Division of Respiratory Medicine, Department of Medicine, University of Cambridge, Box 157, Addenbrooke's NHS Trust, Hills Rd, Cambridge, UK.
Chest. 2006 Jun;129(6):1718-21. doi: 10.1378/chest.129.6.1718.
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.
实体器官移植后肺部浸润的鉴别诊断范围广泛，包括机会性感染和药物性肺病。我们报告了一名成年肝移植受者，在使用西罗莫司后出现呼吸困难和肺部浸润，经支气管活检显示为肉芽肿性间质性肺炎和机化性肺炎，伴有CD4 T细胞浸润，提示对西罗莫司加工后的蛋白复合物存在T辅助细胞相关反应。停用西罗莫司后，临床和影像学迅速改善。该病例表明，随着西罗莫司使用的增加，临床医生需要意识到该药物引起的肺部超敏反应。
