Sirolimus-induced pneumonitis in a renal transplant recipient

Kim, Jin Seok; Shin, Ah Young; Kim, Jeong Ho; Kim, Eun Hye; Oak, Ju Hyun; Yang, Chul Woo

Abstract

Sirolimus is a promising immunosuppressive agent with low nephrotoxicity and anti-tumor effects; it replaces calcineurin inhibitors, but serious adverse effects have been reported. We report on sirolimus-induced pneumonitis, which is a rare but fatal complication. The patient was a 51-year-old renal transplant recipient who had received sirolimus for 3 months before admission. The patient had a productive cough and mild fever, which began 3 weeks before admission. The chest PA and CT findings were consistent with pneumonia, but a microbiological study and bronchoscopic findings revealed no evidence of infection. Sirolimus-induced pneumonitis was suspected, so the sirolimus was stopped and high-dose steroids were initiated. The respiratory symptoms and radiologic findings improved dramatically after sirolimus withdrawal and the initiation of steroid treatment. These findings strongly suggest a casual relationship between sirolimus and pneumonitis. This is the first case of sirolimus-induced pneumonitis in Korea.