Introduction: Pulmonary toxicity of Everolimus is a rare side effect that consists of diverse entities such as interstitial pneumonitis, lymphocytic alve- olitis, bronchiolitis obliterans with organizing pneumonia and, very rarely, dif- fuse alveolar hemorrhage. Case report: A 51-year-old male affected by end-stage renal disease related to diabetic nephropathy underwent single kidney transplantation (KTx) from a standard DBD donor. Two months after KTx patient shown haemoptysis and shortness of breath; auscultation revealed diffuse inspiratory crackles and expiratory wheezing over both lungs. HRCT shown bilateral multiple “ground-glass”-like areas and infiltrated consistent with alveolar hemorrage. Rhinopharyingeal swab for Sars-CoV-2 was negative. Empiric antibiotic therapy with pipiracillin/tazobac- tam was started with no response and blood tests shown severe anemization. Everolimus therapy was suspended and patient was hospitalized for severe respiratory failure, requiring high flux O2 therapy, and blood transfusion. BAL shown progressively more bloody samples, typical of diffuse alveolar hemorrhage, whose analysis was negative for bacterial, viral and fungal cul- ture while the cytological evaluation detected several hemosiderin-laden macrophages (>20%). ANCA and Ab antiGBM were negative; blood and respiratory cultures were negative. Respiratory clinical picture progressively improved after everoli- mus discontinuation, patient was discharged after 9 days and follow-up HRCT shown global improvement. Ten days after patient was re-admitted due to a relapse of the haemoptysis and respiratory symptoms. A new HRCT shown a re-worsening of pul- monary inflammatory infiltrates and ground glass areas requiring high dosage intravenous pulse steroids to achive complete resolution of symp- toms and radiological picture. Conclusion: Pulmonary toxicity related to everolimus is a rare complication that must be always considered as differential diagnosis in patients com- plaining respiratory symptoms. Prompt recognition, managing and treatment of this class-related side effect is crucial to guarantee good outcomes of these patients
Busutti, M., Natali, F., Cingolani, A., Mattiotti, M., Grandinetti, V., Baraldi, O., et al. (2021). A RARE CASE EVEROLIMUS-ASSOCIATED ALVEOLAR HEMORRAGE IN A KIDNEY TRANSPLANT RECIPIENT. TRANSPLANT INTERNATIONAL, 34, 387-387.
A RARE CASE EVEROLIMUS-ASSOCIATED ALVEOLAR HEMORRAGE IN A KIDNEY TRANSPLANT RECIPIENT
Busutti, M;Mattiotti, M;Grandinetti, V;Baraldi, O;Comai, G;La Manna, G
2021
Abstract
Introduction: Pulmonary toxicity of Everolimus is a rare side effect that consists of diverse entities such as interstitial pneumonitis, lymphocytic alve- olitis, bronchiolitis obliterans with organizing pneumonia and, very rarely, dif- fuse alveolar hemorrhage. Case report: A 51-year-old male affected by end-stage renal disease related to diabetic nephropathy underwent single kidney transplantation (KTx) from a standard DBD donor. Two months after KTx patient shown haemoptysis and shortness of breath; auscultation revealed diffuse inspiratory crackles and expiratory wheezing over both lungs. HRCT shown bilateral multiple “ground-glass”-like areas and infiltrated consistent with alveolar hemorrage. Rhinopharyingeal swab for Sars-CoV-2 was negative. Empiric antibiotic therapy with pipiracillin/tazobac- tam was started with no response and blood tests shown severe anemization. Everolimus therapy was suspended and patient was hospitalized for severe respiratory failure, requiring high flux O2 therapy, and blood transfusion. BAL shown progressively more bloody samples, typical of diffuse alveolar hemorrhage, whose analysis was negative for bacterial, viral and fungal cul- ture while the cytological evaluation detected several hemosiderin-laden macrophages (>20%). ANCA and Ab antiGBM were negative; blood and respiratory cultures were negative. Respiratory clinical picture progressively improved after everoli- mus discontinuation, patient was discharged after 9 days and follow-up HRCT shown global improvement. Ten days after patient was re-admitted due to a relapse of the haemoptysis and respiratory symptoms. A new HRCT shown a re-worsening of pul- monary inflammatory infiltrates and ground glass areas requiring high dosage intravenous pulse steroids to achive complete resolution of symp- toms and radiological picture. Conclusion: Pulmonary toxicity related to everolimus is a rare complication that must be always considered as differential diagnosis in patients com- plaining respiratory symptoms. Prompt recognition, managing and treatment of this class-related side effect is crucial to guarantee good outcomes of these patientsI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
