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Case Reports
. 2014 Apr 12;4(1):75-81.
doi: 10.1159/000362361. eCollection 2014 Jan.

Pulmonary toxicity in a renal transplant recipient treated with amiodarone and everolimus: a case of hypothetical synergy and a proposal for a screening protocol

Alberto Mella  1 , Maria Messina  1 , Andrea Ranghino  1 , Paolo Solidoro  2 , Giuseppe Tabbia  2 , Giuseppe Paolo Segoloni  1 , Luigi Biancone  1
Affiliations
Case Reports

Pulmonary toxicity in a renal transplant recipient treated with amiodarone and everolimus: a case of hypothetical synergy and a proposal for a screening protocol

Alberto Mella et al. Case Rep Nephrol Urol. .

Abstract

Pneumotoxic drugs like amiodarone and m-TOR inhibitors (m-TORi) may be administered contemporaneously in therapy for patients who had renal transplants. We present a case of amiodarone pulmonary toxicity (APT) in a patient treated with amiodarone and everolimus. A 57-year-old Caucasian male, under treatment with both everolimus (for 3 years) and amiodarone (for 2 months), presented with fever, dyspnoea and a negative chest X-ray after his second kidney transplant with suboptimal serum creatinine (3 mg/dl). A non-contrastive high-resolution CT scan showed bilateral interstitial lung disease with an associated reduction in carbon monoxide diffusing capacity. Bronchoalveolar lavage (BAL) was negative for an infection, but BAL cytology was suitable for APT (50% of 'foamy' macrophages). A complete recovery was achieved after amiodarone interruption and an oral steroid therapy increase. Everolimus was continued. His kidney function remained unchanged in the upcoming months. In conclusion, we suggest a possible synergistic effect between m-TORi and amiodarone. Furthermore, we propose a diagnostic algorithm that can be used as a surveillance tool to identify a potential initial lung damage in patients treated with 1 or more pneumotoxic drugs.

Keywords: Amiodarone; Everolimus; Pulmonary toxicity; Renal transplant.

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Figures

Fig. 1
Fig. 1
Amiodarone mechanisms of lung toxicity. AEC = Alveolar epithelial cells; Th1 = T helper type 1 lymphocyte; Th2 = T helper type 2 lymphocyte; TNF-α = tumour necrosis factor-α; TGF-β = transforming growth factor-β.
Fig. 2
Fig. 2
Scheme for a hypothetical synergistic effect between m-TORi and amiodarone in lung toxicity. Promoting effect: white arrows; inhibiting effect: black arrows.
Fig. 3
Fig. 3
Surveillance algorithm. Δ = difference (in %) between the last 2 DLCO tests.
See this image and copyright information in PMC

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