Neumonía intersticial asociada a sirolimus en un paciente con trasplante hepático

Abstract

RESUMEN: Con la utilización de sirolimus en pacientes trasplantados, se han reportado casos de neumonitis intersticial, bronquiolitis obliterante y neumonía organizada. Nosotros describimos un caso de toxicidad pulmonar asociada al uso de sirolimus en un paciente de 59 años con trasplante hepático, revisamos los reportes de caso donde se describía toxicidad pulmonar asociada al uso de sirolimus en pacientes con trasplante hepático, con el objetivo de encontrar similitudes en factores de riesgo, manifestaciones clínicas y desenlaces. De los cinco casos reportados desde enero de 2000, incluyendo el presente, encontramos que las manifestaciones clínicas fueron similares presentándose fiebre, disnea, fatiga, tos y hemoptisis. Con la suspensión del medicamento, los pacientes resolvieron sus signos, síntomas y hallazgos imagenológicos.

La toxicidad pulmonar asociada a sirolimus debe ser considerada como diagnóstico diferencial de aquellos pacientes con trasplante hepático que reciban este medicamento y presenten manifestaciones respiratorias, pues la suspensión del medicamento lleva a la resolución del cuadro.

ABSTRACT: Sirolimus is an immunosuppressive drug that has been used during the past few years. Sirolimus is indicated in rescue therapies and to reduce the secondary toxic effects of calcineurin inhibitors. This drug has been associated with infrequent but severe pulmonary toxicity. Cases of interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia, and alveolar proteinosis have been described. We describe a case of pulmonary toxicity associated with the use of sirolimus in a 59-yr-old liver transplant recipient. We also review all reported cases of sirolimus-associated lung toxicity among liver transplantation recipients, with the intention of understanding the risk factors, the clinical picture and the outcomes of this complication. Five cases have been reported since January 2000, including the present case. Clinical presentation is similar, with fever, dyspnea, fatigue, cough, and hemoptysis. Discontinuation of the drug led to resolution of clinical and radiographic findings. Sirolimus-induced pulmonary toxicity is a serious condition and should be considered in the differential diagnosis of liver recipients presenting with respiratory findings. Discontinuation of the drug is associated with resolution of the pulmonary compromise.