title: Sirolimus-associated diffuse alveolar hemorrhage.
abstract: Sirolimus is an immunosuppressive medication used in transplant recipients. To our knowledge, we describe the third reported case of alveolar hemorrhage in association with sirolimus. Fever, dyspnea, hemoptysis, and lung infiltrates resolved rapidly with cessation of sirolimus therapy both initially and after reinstitution of the drug. Unlike previous reports, our patient had no evidence of lymphocytic alveolitis but rather marked macrophage hemosiderosis, suggesting that sirolimus pulmonary toxicity may manifest through 2 separate mechanisms. Our case highlights an uncommon but potentially lethal manifestation of sirolimus pulmonary toxicity.
authors.affiliation: Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. vlahakis.nicholas@mayo.edu
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Vlahakis
authors.forename: Otis B
authors.initials: OB
authors.lastname: Rickman
authors.forename: Timothy
authors.initials: T
authors.lastname: Morgenthaler
mesh_terms: D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid; D004417:Dyspnea / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D006469:Hemoptysis / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D006485:Hemosiderin / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000276:immunology; D008171:Lung Diseases / Q000139:chemically induced* / Q000175:diagnosis; D008264:Macrophages / Q000737:chemistry / Q000473:pathology; D008875:Middle Aged; D011650:Pulmonary Alveoli; D020123:Sirolimus / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents; D006485:Hemosiderin; D020123:Sirolimus