Generalized, pruritic, ulcerating maculopapular rash necessitating cessation of sirolimus in a liver transplantation patient.
The use of sirolimus as an alternative to calcineurin antagonists has enabled the continuation of immunosuppression in patients with renal impairment with preservation of kidney function. Sirolimus is generally well tolerated, with the main causes of cessation of therapy related to its effect on blood lipid profile as well as leukopenia and thrombocytopenia. We report a case of a debilitating ulcerating maculopapular rash necessitating cessation of the drug in a liver transplantation patient. A 56-year-old Caucasian liver transplantation patient presented with a diffuse, debilitating rash attributed to sirolimus use. This ultimately necessitated cessation of the immunosuppressant with subsequent resolution of her symptoms. From a review of the current literature, this is a highly unusual adverse reaction to sirolimus.
Tracey
Christopher
C
Department of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia. ctracey@mmri.mater.org.au
Hawley
Carmel
C
Griffin
Anthony Donald
AD
Strutton
Geoff
G
Lynch
Stephen
S
D004334:Drug Administration Schedule; D003875:Drug Eruptions / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016031:Liver Transplantation; D008875:Middle Aged; D011537:Pruritus / Q000139:chemically induced* / Q000473:pathology; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012883:Skin Ulcer / Q000139:chemically induced* / Q000473:pathology
D007166:Immunosuppressive Agents; D020123:Sirolimus