신장이식 환자에서 발생한 시롤리무스에 의한 폐렴

Sirolimus-induced pneumonitis in a renal transplant recipient

Sirolimus에 의한 폐렴은 드믈지만 사망사례가 보고될 정도로 심각한 질환으로, 빠른 진단과 sirolimus의 사용 중단으로 대부분 후유증없이 치료될 수 있다는 점에서 주의가 요구되는 합병증이라 할 수 있다. 저자들은 신이식 후 sirolimus를 3개월간 사용하던 51세 남자 환자에서 sirolimus에 의한 폐렴을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Sirolimus is a promising immunosuppressive agent with low nephrotoxicity and anti-tumor effects; it replaces calcineurin inhibitors, but serious adverse effects have been reported. We report on sirolimus-induced pneumonitis, which is a rare but fatal complication. The patient was a 51-year-old renal transplant recipient who had received sirolimus for 3 months before admission. The patient had a productive cough and mild fever, which began 3 weeks before admission. The chest PA and CT findings were consistent with pneumonia, but a microbiological study and bronchoscopic findings revealed no evidence of infection. Sirolimus-induced pneumonitis was suspected, so the sirolimus was stopped and high-dose steroids were initiated. The respiratory symptoms and radiologic findings improved dramatically after sirolimus withdrawal and the initiation of steroid treatment. These findings strongly suggest a casual relationship between sirolimus and pneumonitis. This is the first case of sirolimus-induced pneumonitis in Korea.