title: Pulmonary alveolar proteinosis: a rare pulmonary toxicity of sirolimus.
abstract: The aim of our paper is to describe an unusual pulmonary toxicity of sirolimus (SRL) in a kidney transplant recipient. We present a 34-year-old woman with a second renal transplantation, complicated with steroid-resistant acute rejection and chronic allograft dysfunction. Two years after initiating SRL, she presented complaints of progressive dyspnoea, nonproductive cough, chest pain and low-grade fever of 1 month duration. She had chronic allograft nephropathy and slight elevation of lactic dehydrogenase levels. After exclusion of common reasons of this condition, a computed tomography (CT) of the thorax and bronchoscopy was performed, revealing ground-glass opacification with polygonal shapes on CT and an opaque appearance with numerous macrophages on bronchoalveolar lavage. The alveolar macrophages stained positive by Periodic acid-Schiff. Diagnosis of pulmonary alveolar proteinosis (PAP) was made and drug-induced toxicity was suspected. SRL was withdrawn with marked improvement in the patients' clinical and radiological status. PAP resolved within 3 months without further therapy. PAP is a very rare complication of SRL therapy with only a few cases described. Withdrawal of SRL with conversion to another immunosuppressant seems to be an appropriate procedure in this condition.
authors.affiliation: Nephrology Department, Hospital Geral de Santo António, Porto, Portugal. sofiapedroso@sapo.pt
authors.forename: Sofia L
authors.initials: SL
authors.lastname: Pedroso
authors.forename: La Salete
authors.initials: LS
authors.lastname: Martins
authors.forename: Sónia
authors.initials: S
authors.lastname: Sousa
authors.forename: Abílio
authors.initials: A
authors.lastname: Reis
authors.forename: Leonídio
authors.initials: L
authors.lastname: Dias
authors.forename: António C
authors.initials: AC
authors.lastname: Henriques
authors.forename: António M
authors.initials: AM
authors.lastname: Sarmento
authors.forename: António
authors.initials: A
authors.lastname: Cabrita
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D011649:Pulmonary Alveolar Proteinosis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D020123:Sirolimus / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus