Lanfranco Julio, Holt Andrew, Montague Allison, Oza Twisha H, Elballat Mohammad, Romero-Legro Ivan H
University of Tennessee Health Science Center, USA.
Respir Med Case Rep. 2021 Jan 24;32:101347. doi: 10.1016/j.rmcr.2021.101347. eCollection 2021.
Organizing pneumonia is characterized by a distinct histologic pattern in the lung interstitium and presents clinically as hypoxemia, fever, cough, and dyspnea that is not attributable to concurrent infection. Typical etiologies of this condition include inflammatory disease, malignancy, toxic inhalation, and an array of medications including the mTOR inhibitor everolimus. In this report, we describe the case of a female with tuberous sclerosis complex on everolimus therapy for renal angiomyolipomas who presented to the hospital with persistent cough, dyspnea, and fevers and bilateral lower lobe opacities on chest X-ray despite multiple courses of antibiotic therapy. Bronchoscopy was performed with transbronchial biopsies, and results demonstrated a lymphocytic predominance and pathologic findings of intraluminal plugs composed of fibroblasts and myofibroblasts consistent with organizing pneumonia. Everolimus therapy was discontinued and patient completed a steroid course with resolution of symptoms. To our knowledge, this is the first published case of organizing pneumonia secondary to everolimus in a patient with tuberous sclerosis complex.
机化性肺炎的特征是肺间质出现独特的组织学模式，临床上表现为低氧血症、发热、咳嗽和呼吸困难，且这些症状并非由并发感染引起。该病症的典型病因包括炎症性疾病、恶性肿瘤、有毒气体吸入以及一系列药物，其中包括mTOR抑制剂依维莫司。在本报告中，我们描述了一名患有结节性硬化症复合体的女性病例，该患者因肾血管平滑肌脂肪瘤接受依维莫司治疗，尽管接受了多疗程抗生素治疗，但仍因持续咳嗽、呼吸困难和发热到医院就诊，胸部X光显示双侧下叶有模糊影。进行了支气管镜检查并取了经支气管活检，结果显示以淋巴细胞为主，且病理结果显示管腔内有由成纤维细胞和肌成纤维细胞组成的栓子，符合机化性肺炎。停用了依维莫司治疗，患者完成了一个疗程的类固醇治疗，症状得以缓解。据我们所知，这是首例发表的结节性硬化症复合体患者继发于依维莫司的机化性肺炎病例。
