title: Pulmonary hemorrhage with capillaritis secondary to mycophenolate mofetil in a heart-transplant patient.
abstract: Immunosuppressive drugs are an integral part of therapy in organ transplantation. However, they are not without side effects, and although rare, these agents should be considered in the differential diagnosis of pulmonary complications in patients receiving transplants. We present a case of a patient who developed acute respiratory failure 7 days after orthotopic heart transplantation and who had been on both mycophenolate mofetil (MMF) and tacrolimus agents. Lung biopsy revealed features of pulmonary hemorrhage with capillaritis. Considered as a possible etiology, MMF was withdrawn. There was immediate improvement of the patient's symptoms. The temporal relationship between MMF exposure and onset of pulmonary symptoms in the absence of other possible etiologies strongly suggests a causal relationship. Previously published reports of pulmonary toxicity from MMF included interstitial fibrosis. To the best of our knowledge, this is the first reported case of pulmonary hemorrhage with capillaritis because of administration of MMF.
authors.affiliation: From the Departments of Pathology (Drs Gorgan and Fiel-Gan), Radiology (Dr Volpe), Infectious Diseases (Dr Lawlor), and Internal Medicine (Dr Bockorny), Hartford Hospital, Hartford, Connecticut.
authors.forename: Maria
authors.initials: M
authors.lastname: Gorgan
authors.forename: Bruno
authors.initials: B
authors.lastname: Bockorny
authors.forename: Michael
authors.initials: M
authors.lastname: Lawlor
authors.forename: John
authors.initials: J
authors.lastname: Volpe
authors.forename: Mary
authors.initials: M
authors.lastname: Fiel-Gan
mesh_terms: D016027:Heart Transplantation / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008171:Lung Diseases / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016559:Tacrolimus / Q000008:administration & dosage; D014657:Vasculitis / Q000139:chemically induced* / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus