Renal Unit, AZ Sint-Jan AV, Bruges, Belgium.
Chest. 2010 Feb;137(2):456-9. doi: 10.1378/chest.09-0780.
Pulmonary toxicity is a known complication of the proliferation signal inhibitor (PSI) sirolimus and consists of diverse entities such as interstitial pneumonitis, lymphocytic alveolitis, bronchiolitis obliterans with organizing pneumonia, and diffuse alveolar hemorrhage. Several cases of interstitial pneumonitis have also been reported with the more recently developed PSI everolimus. In this report, a case of diffuse alveolar hemorrhage attributed to everolimus is described. The patient presented with respiratory symptoms of insidious onset, ultimately resulting in severe respiratory failure characterized by high lactate dehydrogenase levels, patchy ground-glass infiltrates, and bloody BAL fluid with predominance of iron-loaded macrophages and monocytes. Withdrawal of the offending drug and temporary association of high-dose steroids resulted in a rapid recovery. Given that prompt drug discontinuation is potentially life saving, PSI-induced pulmonary toxicity should be considered in the differential diagnosis of patients treated with PSIs and presenting with respiratory symptoms or pulmonary lesions.
肺毒性是增殖信号抑制剂（PSI）西罗莫司的已知并发症，包括多种实体，如间质性肺炎、淋巴细胞性细支气管炎、闭塞性细支气管炎伴机化性肺炎和弥漫性肺泡出血。最近开发的 PSI 依维莫司也有几例间质性肺炎的报道。在本报告中，描述了一例归因于依维莫司的弥漫性肺泡出血。患者表现为隐匿性发作的呼吸道症状，最终导致严重的呼吸衰竭，其特征是乳酸脱氢酶水平升高、斑片状磨玻璃样浸润和富含铁的巨噬细胞和单核细胞的血性 BAL 液。停用致病药物和暂时联合使用大剂量类固醇导致快速恢复。鉴于迅速停药可能挽救生命，因此对于接受 PSI 治疗并出现呼吸道症状或肺部病变的患者，应考虑 PSI 诱导的肺毒性作为鉴别诊断。
