From the Radiology.
Plastic Surgery Departments, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco.
Ann Plast Surg. 2020 Jan;84(1):113-116. doi: 10.1097/SAP.0000000000002055.
Everolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in solid-organ transplant recipients. Although mTOR inhibitors are usually well tolerated, their adverse effects have been reported: sirolimus treatment in transplant patients has been rarely reported to be associated with lymphedema of the skin and subcutaneous tissues, whereas the use of everolimus seemed to be less burdened by this type of adverse effect. We report the case of a 58-year-old man with a history of end-stage renal disease of unknown etiology who had undergone right renal transplantation 11 years before. After the transplant, the patient soon developed bilateral progressive swelling involving feet and legs. The symptoms of the left limb improved markedly after discontinuing everolimus. This condition has been classified as everolimus-induced lymphedema. The patient was referred to our department for the execution of a noncontrast magnetic resonance lymphangiography, that is, a noninvasive magnetic resonance imaging technique that has recently proposed for the study of lymphedema. Noncontrast magnetic resonance lymphangiography showed asymmetry between the lower extremities with signs of advanced lymphedema located in the right lower limb and dilated peripheral lymphatic vessels.Drug withdrawal is currently the only effective solution for treating this type of secondary lymphedema; however, with the prolonged use of the drug, lymphedema tends to persist even after mTOR inhibitor suspension, with only partial clinical improvement, as in this case.This case report describes the imaging characteristics of such condition at noncontrast magnetic resonance lymphangiography and discusses the rare adverse effects of everolimus. Immediate suspension of the drug is the only effective strategy to avoid the persistence of this disorder.
依维莫司是一种哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂，在实体器官移植受者的免疫抑制治疗方案中使用。虽然 mTOR 抑制剂通常耐受性良好，但已有其不良反应的报道：在移植患者中，西罗莫司治疗与皮肤和皮下组织的淋巴水肿有关的情况很少见，而依维莫司的使用似乎较少受到这种类型的不良反应的影响。我们报告了一例 58 岁男性患者的病例，该患者患有病因不明的终末期肾病，11 年前接受了右肾移植。移植后，患者很快出现双侧进行性足部和腿部肿胀。停用依维莫司后，左侧肢体的症状明显改善。这种情况被归类为依维莫司引起的淋巴水肿。患者因执行非对比磁共振淋巴造影术（一种最近提出用于研究淋巴水肿的无创磁共振成像技术）而被转至我们科。非对比磁共振淋巴造影术显示下肢不对称，右侧下肢有晚期淋巴水肿的迹象，周围淋巴管扩张。目前，停药是治疗这种继发性淋巴水肿的唯一有效方法；然而，随着药物的长期使用，即使在停用 mTOR 抑制剂后，淋巴水肿也往往会持续存在，只有部分临床改善，如本例患者。本病例报告描述了非对比磁共振淋巴造影术对这种情况的影像学特征，并讨论了依维莫司的罕见不良反应。立即停止用药是避免这种疾病持续存在的唯一有效策略。
