Sirolimus induced diffuse alveolar hemorrhage: A case report

Sirolimus, mammalian targets of the Rapamycin, is responsible for inhibition of T and B cell proliferation, and usually. Recently we treated a 33 year old renal transplant reciepent with sirolimus induced diffuse alveolar hemorrhage. She was first diagnosed with pneumonia and underwent antibiotic therapy. In her radiological images there was bilateral diffuse patchy infiltration. In the 48th hour of antibiotic treatment her fever and inflammatory markers were still high, and afterwards, bronchoscopy was performed. Pathology result of the patient was reported as hemosiderin-loaded macrophages, eosinophil predominancy and few lymphocytes . Our final diagnosis was diffuse alveolar hemorrhage due to sirolimus. We discontinued sirolimus and started pulse steroid (1 gr/day methylprednisolon) for three days. In the following period her oxygen supply declined immediately and clinical condition of the patient got better. After two weeks we disharged the patient, continued methylprednisolon treatment in 1mg/kg/day dosage. By tapering the dose slowly we planned 6 months of steroid treatment. During her follow ups, pulmonary symptoms and radiological images got better.