title: Pneumocystis pneumonia in everolimus therapy: An indistinguishable case from drug induced interstitial lung disease.
abstract: A 66-year-old male treated with everolimus for renal cell carcinoma developed exertional dyspnea. Chest computed tomography revealed diffuse interstitial shadows on both lungs. Bronchoalveolar lavage and the drug-induced lymphocyte stimulation test confirmed the diagnosis of drug-induced interstitial lung disease due to everolimus therapy. However, discontinuation of everolimus in combination with corticosteroid therapy did not prevent disease progression. On the basis of a PCR assay for Pneumocystis jirovecii and elevated β-D-glucan levels, trimethoprim-sulfamethoxazole was administered immediately, resulting in a dramatic improvement. This case demonstrated that pneumocystis pneumonia should always be considered and treated during everolimus therapy, even when drug-induced interstitial lung disease is suspected.
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670 Chiba, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670 Chiba, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tada
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670 Chiba, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsushima
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670 Chiba, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Terada
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670 Chiba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Divisions of Control and Treatment of Infectious Diseases, Chiba University Hospital, Chiba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670 Chiba, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Kasahara
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670 Chiba, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanabe
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670 Chiba, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tatsumi
keywords: Bronchoalveolar lavage; Drug-induced interstitial lung disease; Everolimus; Pneumocystis jirovecii