title: Pneumocystis jirovecii pneumonia under everolimus in two patients with metastatic pancreatic neuroendocrine tumors.
abstract: BACKGROUND
  Everolimus, an mTOR inhibitor with immunosuppressive properties, is used in several types of advanced tumors. Materials and
  
  
  METHODS
  We describe the first two cases of Pneumocystis jirovecii pneumonia in patients given everolimus for metastatic pancreatic neuroendocrine tumors.
  
  
  RESULTS
  The first patient presented with respiratory symptoms in the context of grade 4 lymphopenia 2 weeks after starting everolimus; the diagnosis of Pneumocystis jirovecii pneumonia was made post-mortem. After suspecting everolimus-related interstitial pneumonitis in the second patient, Pneumocystis jirovecii was detected, and cotrimoxazole therapy led to a favorable outcome.
  
  
  CONCLUSIONS
  Everolimus may induce pneumonitis, lymphopenia and opportunistic infections. The time from treatment initiation to opportunistic infection may be short. Risk factors in oncology deserve further identification in order to start prophylaxis without delay.
authors.affiliation: Department of Gastroenterology and Digestive Oncology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France, melodie.carbonnaux@chu-lyon.fr.
authors.forename: Mélodie
authors.initials: M
authors.lastname: Carbonnaux
authors.forename: Yann
authors.initials: Y
authors.lastname: Molin
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Souquet
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tantin
authors.forename: Catherine
authors.initials: C
authors.lastname: Lombard-Bohas
authors.forename: Thomas
authors.initials: T
authors.lastname: Walter
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068338:Everolimus; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000188:drug therapy; D009894:Opportunistic Infections / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000188:drug therapy; D045363:Pneumocystis carinii; D011014:Pneumonia / Q000150:complications*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D047428:Protein Kinase Inhibitors; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus