Correct!
5. Sirolimus
Many drugs produce a diffuse clinical spectrum of drug-induced lung disease (DILD) (3). Aside from the cytotoxic agents which can injure the lung through their cytotoxic effects, antibiotics and anti-inflammatory drugs are frequent culprits in producing DILD. Sirolimus is a macrolide antibiotic with potent anti-inflammatory activity. Although its anti-inflammatory activity might be expected to improve DILD, sirolimus can also cause DILD (4). The most commonly presenting symptoms are dyspnea on exertion and dry cough followed by fatigue and fever. Chest radiographs and high-resolution computed tomography scans commonly reveal bilateral patchy or diffuse alveolar-interstitial infiltrates. Bronchoalveolar fluid analysis and lung biopsy in selected case reports revealed several distinct histologic features, including lymphocytic alveolitis, lymphocytic interstitial pneumonitis, bronchoalveolar obliterans organizing pneumonia, focal fibrosis, pulmonary alveolar hemorrhage, or a combination thereof.
As with most DILD, improvement following discontinuation of the drug confirms the diagnosis. However, the patient also has a renal transplant and needs immunosuppression to prevent rejection. In this case the sirolimus was stopped and replaced with tacrolimus and her dose of prednisone increased to 50 mg daily. She had a marked improvement in both her symptoms and her thoracic CT scan (Figure 6).
Figure 6. Panels A-D: Initial CT scan. Panels E-H: Corresponding views after sirolimus discontinued.
The patient is currently taking her prior dose of corticosteroids and has restarted working.
The patient is currently taking her prior dose of corticosteroids and has restarted working.
References