title: Sirolimus induced granulomatous interstitial pneumonitis.
abstract: OBJECTIVE
  Report a case of sirolimus induced granulomatous pneumonitis.
  
  
  BACKGROUND
  Sirolimus is used in clinical transplantation as an immunosuppressive agent. Pulmonary toxicity does occur, but only a few cases of sirolimus associated granulomatous interstitial pneumonitis have been reported.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  This 53-year-old woman with ESRD from polycystic kidney disease status post deceased donor kidney transplantation presented with fever, progressive dyspnea, and hypoxia for two weeks. She had been switched to sirolimus two months before admission. A CT scan of the chest revealed bilateral ill-defined patchy ground glass opacities. Extensive investigations were negative for infection. Video-assisted thoracoscopic biopsy showed granulomatous interstitial pneumonitis. Her symptoms and infiltrates resolved after sirolimus discontinuation and corticosteroid treatment.
  
  
  CONCLUSIONS
  Drugs induced pneumonitis should always be considered in transplant patients after infectious or other etiologies have been excluded. Sirolimus can cause granulomatous infiltrates in the lung possibly secondary to T-cell mediated hypersensitivity.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, United States.
authors.forename: Kamonpun
authors.initials: K
authors.lastname: Ussavarungsi
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, United States.
authors.forename: Abdelaziz
authors.initials: A
authors.lastname: Elsanjak
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, United States.
authors.forename: Melvin
authors.initials: M
authors.lastname: Laski
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, United States.
authors.forename: Rishi
authors.initials: R
authors.lastname: Raj
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, United States.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
keywords: Granulomatous interstitial pneumonitis; Interstitial pneumonitis; Pulmonary toxicity; Renal transplantation; Sirolimus