title: Characteristic features of tacrolimus-induced lung disease in rheumatoid arthritis patients.
abstract: This paper aims to study the background and clinical characteristics of tacrolimus (TAC)-induced lung disease. A case of a rheumatoid arthritis (RA) patient who developed TAC-induced interstitial lung disease (TAC-ILD) is reported. The Japanese Pharmaceuticals and Medical Devices Agency (PMDA) website was searched for cases of TAC-ILD and its prevalence among all cases of TAC-related adverse events. As for cases of TAC-ILD, its underlying disease, preexisting lung diseases, and fatal outcome were also searched. Literature review of TAC-ILD cases was added. A 65-year-old female RA patient with preexisting bronchiectasis developed near-fatal TAC-ILD. Amelioration of RA, ground-glass opacities in the upper, anterior, and central lung fields, and decrease in peripheral blood lymphocyte count were the major findings in this patient. A search of the PMDA website revealed the following: the prevalence of TAC-ILD was 3 % of all cases of TAC-related adverse events, 56 out of 85 RA cases (66 %), and one out of 15 other cases had a preexisting lung disease; the prevalences of fatal outcome in RA and other cases were 24 and 38 %, respectively. A few cases in the literature had preexisting ILD and developed diffuse alveolar damage. In our case, preexisting bronchiectasis, arthritis remission, newly developed ground-glass opacities (GGOs) in the upper, anterior, and central lung fields, and decrease in peripheral blood lymphocyte count were the major findings. From the search of the PMDA website, about one fourth of the cases with TAC-related lung injury had a fatal outcome, and among RA patients, two thirds had preexisting lung diseases.
authors: Department of Allergy and Rheumatic Diseases, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
authors: Takanori
authors: T
authors: Sasaki
authors: Department of Allergy and Rheumatic Diseases, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
authors: Wataru
authors: W
authors: Nakamura
authors: Department of Allergy and Rheumatic Diseases, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. inokuma_shigeko@med.jrc.or.jp.
authors: Shigeko
authors: S
authors: Inokuma
authors: Department of Allergy and Rheumatic Diseases, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
authors: Erika
authors: E
authors: Matsubara
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008171:Lung Diseases / Q000139:chemically induced*; D016559:Tacrolimus / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Diffuse alveolar damage; Fatal; Lung injury; Lymphocyte; Rheumatoid arthritis; Tacrolimus
references: Rheumatology (Oxford). 2009 Sep;48(9):1069-72
references: 19321513
references: Lancet. 1999 May 22;353(9166):1762-3
references: 10347992
references: Arthritis Rheum. 1997 Jun;40(6):1157-67
references: 9182928
references: J Rheumatol. 1996 Jul;23 (7):1282-5
references: 8823707
references: Mod Rheumatol. 2008;18(2):208-11
references: 18306979
references: Clin Exp Rheumatol. 2005 Sep-Oct;23(5):707-10
references: 16173253
references: Ann Rheum Dis. 2006 Aug;65(8):1113-4
references: 16837494
references: Pulm Pharmacol Ther. 2011 Aug;24(4):401-6
references: 21300166
references: Immunol Today. 1992 Apr;13(4):136-42
references: 1374612
references: Expert Opin Drug Saf. 2011 Jul;10 (4):603-11
references: 21410426
references: Radiology. 2004 Jul;232(1):81-91
references: 15166329
references: Ann N Y Acad Sci. 1993 Nov 30;696:9-19
references: 7509138