Pulmonary alveolar proteinosis: a rare pulmonary toxicity of sirolimus.
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 SRL was withdrawn with marked improvement in the patients' clinical and radiological status.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.
Pedroso
Sofia L
SL
Nephrology Department, Hospital Geral de Santo António, Porto, Portugal. sofiapedroso@sapo.pt
Martins
La Salete
LS
Sousa
Sónia
S
Reis
Abílio
A
Dias
Leonídio
L
Henriques
António C
AC
Sarmento
António M
AM
Cabrita
António
A
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
D007166:Immunosuppressive Agents; D020123:Sirolimus