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Sirolimus-Induced Pulmonary Hypersensitivity Associated With a CD4 T-Cell Infiltrate*

Luke Howard, DPhil; Deepa Gopalan, MD; Meryl Griffiths, MD; Ravi Mahadeva, PhD
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*From the Division of Respiratory Medicine (Drs. Howard and Mahadeva), Department of Medicine, University of Cambridge, Cambridge; and Departments of Radiology (Dr. Gopalan) and Histopathology (Dr. Griffiths), Addenbrooke’s NHS Trust, Hills Road, Cambridge, UK.

Correspondence to: Luke Howard, DPhil, Division of Respiratory Medicine, Department of Medicine, University of Cambridge, Box 157, Addenbrooke’s NHS Trust, Hills Rd, Cambridge, UK; e-mail: lshoward@hhnt.nhs.uk



Chest. 2006;129(6):1718-1721. doi:10.1378/chest.129.6.1718
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The differential diagnosis of pulmonary infiltrates after solid-organ transplantation presents a broad differential diagnosis including opportunistic infections and drug-induced lung disease. We report an adult liver transplant recipient who had breathlessness and pulmonary infiltrates following the introduction of sirolimus, and in whom transbronchial biopsy demonstrated a granulomatous interstitial pneumonitis and an organizing pneumonia with a CD4 T-cell infiltrate suggesting a T-helper cell-associated reaction to a processed sirolimus protein complex. Withdrawal of sirolimus produced a rapid clinical and radiologic improvement. This case indicates that with the increasing use of sirolimus, clinicians need to be aware of pulmonary hypersensitivity from this agent.

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