[mTOR-induced pneumonitis in a 72-year-old patient after heart transplantation]

A 72-year-old heart transplant recipient presented to the hospital with progressive dyspnea. His immunosuppressive therapy was switched to the mTOR-inhibitor everolimus. A few months before, due to a progressive decline in renal function. Primarily, a community-acquired pneumonia was suspected and an empiric antibiotic therapy was initiated. Despite antimicrobial treatment, an acute respiratory distress syndrome developed and mechanical ventilation became necessary.

During the following extensive diagnostic a transbronchial lung biopsy was performed and histological analysis revealed a drug induced lung injury.

Based on the clinical and histological findings an everolimus induced pneumonitis was suspected.

The drug was immediately discontinued and a high-dose steroid treatment was started, resulting in a significant improvement of respiratory function.

Everolimus-related interstitial pneumonitis represents a rare but important adverse effect of everolimus in immunosuppressed patients. Recognition of everolimus induced pneumonitis is of high clinical relevance and should be considered in all patients on everolimus presenting with respiratory symptoms of unknown origin.