Sirolimus-associated acute respiratory distress syndrome in a renal transplant recipient.
Sirolimus is a new potent immunosuppressive drug used in organ transplantation; its major advantage is the absence of deterioration in renal function. Documented adverse effects include myelosuppression and hyperlipidemia. Recently several cases of sirolimus-associated interstitial pneumonitis have been reported, usually of mild severity. We report a new case that was complicated by a severe acute respiratory distress syndrome, which required several days of mechanical ventilation. No infectious or cardiogenic etiology was documented. Low sirolimus blood levels and acute CD4 lymphocytic alveolitis suggested an immune-related mechanism rather than a direct toxic effect of the drug. The patient recovered after discontinuation of sirolimus and the administration of corticosteroids.
Amigues
L
L
Department of Intensive Care, Lapeyronie University Hospital, Montpellier, France.
Klouche
K
K
Massanet
P
P
Gaillard
N
N
Garrigue
V
V
Beraud
J-J
JJ
Mourad
G
G
D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D020123:Sirolimus / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D020123:Sirolimus; D008775:Methylprednisolone