Detroyer D, Deraedt K, Schöffski P, Hauben E, Lagrou K, Naesens M, Delforge M L, Kuypers D
Department of Nephrology, UZ Leuven, Leuven, Belgium.
Transpl Infect Dis. 2015 Apr;17(2):303-7. doi: 10.1111/tid.12357. Epub 2015 Mar 7.
We present a case report of a patient with diffuse skin and systemic Kaposi's sarcoma (KS), 1 year after renal transplantation. A concomitant Pyrenochaeta romeroi granuloma of the right hallux was diagnosed and illustrated an important immunodysfunction in our patient. Four months after reduction in immunosuppression and switch to everolimus, a total regression of the KS was observed. Reduction in the immunosuppression and treatment with terbinafine cleared the P. romeroi infection, while lowering immunosuppression and changing the type of immunosuppressive therapy were important steps in the successful management of the KS. In recent years, evidence of the antitumor effects of everolimus is increasing: total regression of KS in combination with renal function preservation in renal graft recipients is possible with mammalian target of rapamycin (mTOR) inhibitor-based regimens. In addition, with increasing numbers of human immunodeficiency virus-positive transplant recipients, mTOR inhibitors may play a more crucial role in the management of KS.
我们报告一例肾移植术后1年出现弥漫性皮肤和系统性卡波西肉瘤（KS）的患者。同时诊断出右拇趾伴有罗梅罗拟茎点霉肉芽肿，这表明我们的患者存在重要的免疫功能障碍。在免疫抑制减少并改用依维莫司4个月后，观察到KS完全消退。免疫抑制的减少和特比萘芬治疗清除了罗梅罗拟茎点霉感染，而降低免疫抑制和改变免疫抑制治疗类型是成功治疗KS的重要步骤。近年来，依维莫司抗肿瘤作用的证据越来越多：基于雷帕霉素哺乳动物靶点（mTOR）抑制剂的方案有可能使肾移植受者的KS完全消退并保留肾功能。此外，随着人类免疫缺陷病毒阳性移植受者数量的增加，mTOR抑制剂可能在KS的管理中发挥更关键的作用。
