title: Early everolimus-induced pneumonitis in a renal transplant recipient: A case report.
abstract: BACKGROUND
  Everolimus is a derivative of sirolimus, and is considered to be free of the latter's pulmonary toxicity. Recently, a few cases of everolimus-induced lung injury have been reported. Early recognition of drug-induced lung disease is important because it can be reversed if appropriate therapy is instituted soon after the onset of symptoms.
  
  
  METHODS
  We present the case of an everolimus-induced pneumonitis in a renal transplant recipient, which occurred as early as on the 5th day after everolimus introduction. Shortly after the transplant procedure, the patient presented with typical symptoms of pulmonary infection. Chest radiography and computed tomography showed bilateral patchy lung infiltrates with peribronchial distribution that were suggestive of bacterial pneumonia. However, there was no improvement with empiric antibiotic treatment. Repeated cultures from the blood, sputum, and broncho-alveolar lavage (BAL) also were negative. Tuberculosis, Pneumocystis jiroveci, and Cytomegalovirus infections were excluded. A transbronchial lung biopsy performed 9 days after the onset of symptoms revealed mild nonspecific inflammation with a fibrotic component in the bronchial walls. Withdrawal of everolimus on the third day of hospitalization and after 8 days of its usage resulted in quick clinical recovery and resolution of radiological abnormalities within 1 month.
  
  
  CONCLUSIONS
  Diagnosis of drug-induced pulmonary toxicity is difficult because it is essentially a diagnosis of exclusion. Lack of response to empiric antibiotic treatment and an imaging pattern of organizing pneumonia should raise suspicion of everolimus-induced pneumonitis in patients undergoing therapy with this drug.
authors.affiliation: 1st Department of Clinical Radiology, Medical University of Warsaw, Chałubińskiego 5 St., Warsaw, Poland. kkornatowska@tlen.pl
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Sułkowska
authors.forename: Piotr
authors.initials: P
authors.lastname: Palczewski
authors.forename: Dorota
authors.initials: D
authors.lastname: Miszewska-Szyszkowska
authors.forename: Magdalena
authors.initials: M
authors.lastname: Durlik
authors.forename: Marek
authors.initials: M
authors.lastname: Gołębiowski
authors.forename: Piotr
authors.initials: P
authors.lastname: Małkowski
mesh_terms: D000328:Adult; D000068338:Everolimus; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus