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Inicio Medicina Clínica (English Edition) Sirolimus associated pneumonitis in a hematopoietic stem cell transplant patient
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Vol. 145. Issue 1.
Pages 21-23 (July 2015)
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Vol. 145. Issue 1.
Pages 21-23 (July 2015)
Clinical report
DOI: 10.1016/j.medcle.2015.12.042
Sirolimus associated pneumonitis in a hematopoietic stem cell transplant patient
Neumonitis intersticial asociada a sirolimus en un paciente receptor de un trasplante de progenitores hematopoyéticos
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Estefanía García, Diana Buenasmañanas, Carmen Martín, Rafael Rojas
Corresponding author
rrojashurs@hotmail.com

Corresponding author.
Servicio de Hematología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Abstract
Background and objective

Sirolimus (SR) is a lipophilic macrocytic lactone with immunosuppressive properties (mTOR inhibitor) commonly used in solid organ transplantation and recently introduced in the prophylaxis and treatment of graft-versus-host disease. Its numerous side effects include: hyperlipidemia, arthralgias, noncardiac peripheral oedema, thrombotic microangiopathy and interstitial pneumonitis. SR-associated pneumonitis is a rare but potentially serious complication due to its increasing utilisation in transplant patients.

Patient and method

We report the case of a patient undergoing hematopoietic stem cell transplantation with severe respiratory distress and SR therapy.

Results

Microbiological tests were all negative and other complications related to transplantation were discarded. The chest computed tomography of high-resolution showed pneumonitis. The SR therapy was interrupted and treatment was started with steroids with resolution of symptoms.

Conclusions

SR associated pneumonitis is a potentially fatal side effect. In patients treated with SR and respiratory failure, we must suspect this complication because early recognition along with drug discontinuation and steroid treatment is essential to reverse this complication.

Keywords:
Sirolimus
Hematopoietic stem cell transplant
Pneumonitis and pulmonary toxicity
Resumen
Fundamento y objetivo

Sirolimus (SR) es una lactona macrocíclica lipofílica con propiedad inmunosupresora (inhibidor de mTOR) comúnmente usado en el trasplante de órganos sólidos y progenitores hematopoyéticos. Sus numerosos efectos secundarios incluyen: hiperlipidemia, artralgias, oedema periférico de origen no cardiaco, microangiopatía trombótica y neumonitis intersticial. La neumonitis asociada a SR es un cuadro poco frecuente pero potencialmente grave y preocupante debido a la creciente utilización de este fármaco en los pacientes trasplantados.

Paciente y método

Se presenta el caso de un paciente sometido a trasplante de progenitores hematopoyéticos con insuficiencia respiratoria grave bajo tratamiento inmunosupresor con SR.

Resultados

Los estudios microbiológicos fueron negativos y se descartaron otras complicaciones relacionadas con el trasplante. Los resultados de la tomografía axial computarizada de alta resolución mostraron un cuadro de neumonitis. Se suspende SR y se inicia tratamiento con esteroides, produciéndose la resolución del cuadro.

Conclusiones

La neumonitis asociada a SR es un efecto adverso potencialmente mortal. Ante un paciente bajo tratamiento con SR e insuficiencia respiratoria, debe sospecharse la posibilidad de esta complicación, pues su reconocimiento temprano con suspensión del fármaco y tratamiento con esteroides es fundamental para revertir el cuadro.

Palabras clave:
Sirolimus
Trasplante de progenitores hematopoyéticos
Neumonitis y toxicidad pulmonar

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