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Related Experiment Videos

Sirolimus-associated diffuse alveolar hemorrhage.

Nicholas E Vlahakis1, Otis B Rickman, Timothy Morgenthaler

  • 1Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. vlahakis.nicholas@mayo.edu

Mayo Clinic Proceedings
|April 7, 2004
PubMed
Summary

Sirolimus, an immunosuppressant, can cause alveolar hemorrhage, a rare but serious side effect. This case suggests sirolimus pulmonary toxicity may occur via two distinct mechanisms, highlighting the need for awareness.

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Area of Science:

  • Immunology
  • Pulmonary Medicine
  • Pharmacology

Background:

  • Sirolimus is a crucial immunosuppressive drug for transplant recipients.
  • Pulmonary complications are known adverse effects of sirolimus therapy.
  • Alveolar hemorrhage is a rare but severe manifestation associated with sirolimus.

Observation:

  • A case of alveolar hemorrhage in a transplant recipient receiving sirolimus is presented.
  • The patient experienced fever, dyspnea, hemoptysis, and lung infiltrates.
  • Symptoms rapidly resolved upon sirolimus withdrawal and recurred upon reintroduction.

Findings:

  • This case represents the third reported instance of sirolimus-associated alveolar hemorrhage.
  • Unlike prior reports, this patient showed no lymphocytic alveolitis.

Related Experiment Videos

  • Marked macrophage hemosiderosis was observed, suggesting an alternative mechanism of sirolimus pulmonary toxicity.

    • Implications:

    • Sirolimus-induced pulmonary toxicity may manifest through at least two distinct pathological pathways.
    • Physicians should consider sirolimus-induced alveolar hemorrhage in transplant patients with relevant symptoms.
    • Early recognition and drug cessation are critical for managing this potentially lethal adverse event.