Interstitial Pneumonitis caused by Everolimus
Neumonitis intersticial por everolimus
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Losada González, G. Gómez Marqués, J.G. Martínez Mateu, M.A. Munar Vila, M. Uriol Rivera" "autores" => array:5 [ 0 => array:4 [ "Iniciales" => "G.P." "apellidos" => "Losada González" "email" => array:1 [ 0 => "graciap.losada@ssib.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "G." "apellidos" => "Gómez Marqués" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "J.G." "apellidos" => "Martínez Mateu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "M.A." "apellidos" => "Munar Vila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "Iniciales" => "M." "apellidos" => "Uriol Rivera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Son Dureta, Palma de Mallorca, Islas Baleares, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumonitis intersticial por everolimus" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10337_108_7817_en_10337_f1.jpg" "Alto" => 557 "Ancho" => 663 "Tamanyo" => 22034 ] ] "descripcion" => array:1 [ "en" => "Chest X-ray" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor, </span></p><p class="elsevierStylePara">mTOR inhibitors are immunosuppressors that block proliferation signal and have a lower nephrotoxic potential. However, a series of adverse reactions have been described, especially with sirolimus, among which the most outstanding is pneumonitis.</p><p class="elsevierStylePara">We present the case of a 70 year old man, suffering from hypertension and dyslipidaemia, who received his first kidney transplant from a deceased donor in March 2009, due to chronic kidney disease secondary to chronic pyelonephritis. Immunosuppressive treatment consisted of basiliximab, mycofenolate, everolimus and steroids. The patient presented good evolution, with creatinine on discharge at 1.7 mg/dl.</p><p class="elsevierStylePara">The patient is admitted 4 months after transplant surgery with a fever over 10 days, cough and dyspnoea. On physical examination poor general condition is noted with chills, tachycardia, bilateral crepitation and oxygen saturation of 93% (arterial blood gas: pH 7.50, pCO<span class="elsevierStyleInf">2 </span>26.8, pO<span class="elsevierStyleInf">2 </span>60, HCO<span class="elsevierStyleInf">3 </span>20.9 mmol/l). The patient also presented non-pruriginous erithematous exanthema on the back and chest, with lip herpes.</p><p class="elsevierStylePara">Laboratory findings were 3,980 WBC/µl (eosinophils 29.3%), haemoglobin 12.1 g/dl, platelets 276,000, creatinine 1.79 mg/dl, plasma sodium 138 mEq/l, plasma potassium 3.9 mE/l, and plasma levels of everolimus of 14 ng/ml. On the chest X-ray a bilateral interstitial pattern was seen and the chest CT showed pulmonary nodules and infiltrates with thickening of the bilateral interstitium (Figures 1 and 2). Antigen studies and cultures of cytomegalovirus (CMV) were negative, as also pneumococcal and <span class="elsevierStyleItalic">Legionella </span>antigen studies. A bronchoscopy was performed and signs of chronic bronchopathy were seen with negative BAl and BAS. Empiric treatment with wide spectrum antibiotics and antivirals was begun, without any clinical improvement and with radiological worsening. Therefore, suspecting pneumonitis due to everolimus, we decided to discontinue this drug and introduce tacrolimus. On the day after discontinuing everolimus the patient presented clinical and radiological improvement with resolution of the condition.</p><p class="elsevierStylePara">To summarise, knowing that pneumonitis may appear with all mTOR inhibitors can lead to rapid discontinuation of the drug, preventing unnecessary diagnostic and therapeutic action in kidney transplant patients.</p><p class="elsevierStylePara"><a href="grande/10337_108_7817_en_10337_f1.jpg" class="elsevierStyleCrossRefs"><img src="10337_108_7817_en_10337_f1.jpg" alt="Chest X-ray"></img></a></p><p class="elsevierStylePara">Figure 1. Chest X-ray</p><p class="elsevierStylePara"><a href="grande/10337_108_7818_en_10337_f2.jpg" class="elsevierStyleCrossRefs"><img src="10337_108_7818_en_10337_f2.jpg" alt="Chest CT"></img></a></p><p class="elsevierStylePara">Figure 2. Chest CT</p>" "pdfFichero" => "P1-E501-S2459-A10337-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10337_108_7817_en_10337_f1.jpg" "Alto" => 557 "Ancho" => 663 "Tamanyo" => 22034 ] ] "descripcion" => array:1 [ "en" => "Chest X-ray" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10337_108_7818_en_10337_f2.jpg" "Alto" => 577 "Ancho" => 658 "Tamanyo" => 31843 ] ] "descripcion" => array:1 [ "en" => "Chest CT" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Alexandru S, Ortiz A, Baldovi S, Milicua JM, Ruiz-Escribano E, Egido J, Plaza JJ. Severe everolimus-associated pneumonitis in a renal trasplant recipient. Nephrol Dial Transplant 2008;23(10):3353-5. Epub 2008 Jul 25. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18658177" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Carreño CA, Gadea M. Case report of a kidney transplant recipient converted to everolimus due to malignancy; resolution of bronchiolitis obliterans organizing pneumonia without everolimus discontinuation. Trasplant Proc 2007;39(3):594-5." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003000000004/v0_201502091652/X2013251410050352/v0_201502091652/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003000000004/v0_201502091652/X2013251410050352/v0_201502091652/en/P1-E501-S2459-A10337-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410050352?idApp=UINPBA000064" ]
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