Sułkowska Katarzyna, Palczewski Piotr, Miszewska-Szyszkowska Dorota, Durlik Magdalena, Gołębiowski Marek, Małkowski Piotr
1st Department of Clinical Radiology, Medical University of Warsaw, Chałubińskiego 5 St., Warsaw, Poland.
Ann Transplant. 2012 Dec 31;17(4):144-8. doi: 10.12659/aot.883706.
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.
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.
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.
依维莫司是西罗莫司的衍生物，被认为无后者的肺部毒性。最近，有几例依维莫司引起的肺损伤的报道。药物性肺病的早期识别很重要，因为如果在症状出现后尽早开始适当治疗，病情是可以逆转的。
我们报告一例肾移植受者发生的依维莫司诱发的肺炎，最早在开始使用依维莫司后的第5天出现。移植手术后不久，患者出现典型的肺部感染症状。胸部X线和计算机断层扫描显示双侧斑片状肺浸润，呈支气管周围分布，提示细菌性肺炎。然而，经验性抗生素治疗并无改善。血液、痰液和支气管肺泡灌洗（BAL）的反复培养结果也均为阴性。排除了结核、耶氏肺孢子菌和巨细胞病毒感染。症状出现9天后进行的经支气管肺活检显示轻度非特异性炎症，支气管壁有纤维化成分。住院第三天停用依维莫司，在使用8天后停药，患者临床迅速康复，1个月内放射学异常消失。
药物性肺毒性的诊断很困难，因为它本质上是一种排除性诊断。对经验性抗生素治疗无反应以及呈现机化性肺炎的影像学表现，应引起接受该药治疗患者对依维莫司诱发肺炎的怀疑。
