title: Sirolimus-induced pulmonary hypersensitivity associated with a CD4 T-cell infiltrate.
abstract: The differential diagnosis of pulmonary infiltrates after solid-organ transplantation presents a broad differential diagnosis including opportunistic infections and drug-induced lung disease. We report an adult liver transplant recipient who had breathlessness and pulmonary infiltrates following the introduction of sirolimus, and in whom transbronchial biopsy demonstrated a granulomatous interstitial pneumonitis and an organizing pneumonia with a CD4 T-cell infiltrate suggesting a T-helper cell-associated reaction to a processed sirolimus protein complex. Withdrawal of sirolimus produced a rapid clinical and radiologic improvement. This case indicates that with the increasing use of sirolimus, clinicians need to be aware of pulmonary hypersensitivity from this agent.
authors.affiliation: Division of Respiratory Medicine, Department of Medicine, University of Cambridge, Box 157, Addenbrooke's NHS Trust, Hills Rd, Cambridge, UK. lshoward@hhnt.nhs.uk
authors.forename: Luke
authors.initials: L
authors.lastname: Howard
authors.forename: Deepa
authors.initials: D
authors.lastname: Gopalan
authors.forename: Meryl
authors.initials: M
authors.lastname: Griffiths
authors.forename: Ravi
authors.initials: R
authors.lastname: Mahadeva
mesh_terms: D000368:Aged; D000542:Alveolitis, Extrinsic Allergic / Q000139:chemically induced* / Q000175:diagnosis; D015496:CD4-Positive T-Lymphocytes / Q000502:physiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis; D020123:Sirolimus / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus