A pediatric case of sirolimus-associated pneumonitis after kidney transplantation

Jelte Kelchtermans, Jessica Chang, Wendy Glaberson, Marissa Defreitas, Monica Alba-Sandoval, Jayanthi Chandar

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Sirolimus is an immunosuppressive medication often used in solid organ transplantation. It has been associated with severe side effects, including pulmonary toxicity. In adult patients, a single center study found that 14% of those treated with sirolimus developed pulmonary pneumonitis; however, the incidence in the pediatric population is not known. Most reports in adult patients indicate that elevated drug concentrations and a prolonged duration of use are associated with pulmonary toxicity. We report a case of a 17-year-old male kidney transplant recipient who developed rapid-onset respiratory failure, necessitating mechanical ventilation and acute renal replacement therapy for ultrafiltration secondary to sirolimus-induced pneumonitis. He had been treated for acute rejection with corticosteroids 17 days prior to the development of pneumonitis. His symptoms developed within 1 week of initiation of sirolimus and with a serum concentration of 1.1 ng/mL. Sirolimus was discontinued, and, following aggressive diuresis and ventilatory support, his respiratory status returned to baseline. Sirolimus-induced pneumonitis is an important diagnosis to be considered in any transplant recipient receiving sirolimus with new onset fever, cough, or dyspnea without an identifiable source, especially if there is a preceding history of treatment with high-dose corticosteroids.

Original languageEnglish (US)
Pages (from-to)459-464
Number of pages6
JournalJournal of Pediatric Pharmacology and Therapeutics
Volume25
Issue number5
DOIs
StatePublished - 2020

Keywords

  • Adverse drug reaction
  • Kidney transplant
  • Pediatrics
  • Pneumonitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pharmacology (medical)

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