title: Severe Hypertriglyceridemia Induced by Sirolimus Treated With Medical Management Without Plasmapheresis: A Case Report.
abstract: Hypertriglyceridemia and hyperlipidemia are the most remarkable metabolic complications seen with long-term sirolimus therapy. We report the case of a 36-year-old woman status post bilateral lung transplantation on a maintenance immunosuppression regimen of sirolimus, tacrolimus, and prednisone who presented with status migrainosus, chest pain, abdominal discomfort, and triglyceride levels greater than 4425 mg/dL. In previously reported cases of severe hypertriglyceridemia that developed on maintenance sirolimus therapy, plasmapheresis has been utilized as an early strategy to rapidly lower triglycerides in order to minimize the risk of acute complications such as pancreatitis, but our case was managed medically without plasmapheresis. The most recent triglyceride was down to 520 mg/dL 2 months after discontinuation of sirolimus. We estimate the probability of this reaction to sirolimus as probable based on a score of 5 points on the Naranjo scale. This is the first case report to our knowledge that highlights the sole use of oral lipid-lowering drug agents to treat severe hypertriglyceridemia secondary to sirolimus without the use of plasmapheresis.
  
  
  CONCLUSIONS
  Sirolimus-induced severe hypertriglyceridemia can be managed with oral lipid-lowering agents without plasmapheresis. Clinician needs to be aware of the importance of baseline and regular triglyceride monitoring in patients on sirolimus.
authors.affiliation: 1 Department of Pharmacy Practice, South Dakota State University, Sioux Falls, SD, USA.|2 Department of Pharmacy Service, Avera McKennan Hospital, Sioux Falls, SD, USA.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kido
authors.affiliation: 3 Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.
authors.forename: Rickey A
authors.initials: RA
authors.lastname: Evans
authors.affiliation: 4 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky HealthCare, Lexington, KY, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Gopinath
authors.affiliation: 3 Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Flynn
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000139:chemically induced* / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D010956:Plasmapheresis; D012720:Severity of Illness Index; D020123:Sirolimus / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus
keywords: hyperlipidemia; hypertriglyceridemia; plasmapheresis; severe hypertriglyceridemia; sirolimus