Everolimus-Induced Drug Fever After Heart Transplantation

Dorschner, Lorenz; Speich, R; Ruschitzka, F; Gallino, Augusto; Seebach, Jorg Dieter

doi:10.1097/00007890-200407271-01966

Cited by 3 publications

(4 citation statements)

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“…3,6 The causative relationship was only assumed after thoroughly excluding infection, immune-mediated disorder, and malignancy. The rapid clinical improvement with resolution of symptoms after discontinuation of SIR supported this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…2 Most SIR side effects are dose-related, including oral ulcers, delayed wound healing, lymphoceles, infections, hyperlipidemia, and myelosuppression. 3 More recently, interstitial pneumonitis has been recognized as a side effect of mammalian target of rapamycin (mTOR) inhibitors that might also be related to immune-mediated toxicity. 4,5 …”

Section: S Irolimus (Sir) Is a Macrolide Derivative That Hasmentioning

confidence: 99%

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Sirolimus-Induced Drug Fever in a Renal Transplant Patient: A Case Report

Aires

Carvalho

Remédio

et al. 2009

Transplantation Proceedings

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Herein we have described the case of a male renal transplant recipient who developed drug fever apparently related to sirolimus. He had been stable under an immunosuppressive regimen of tacrolimus and mycophenolate mofetil, but developed acute cellular rejection at 5 years after transplantation due to noncompliance. Renal biopsy showed marked interstitial fibrosis, and immunosuppression was switched from mycophenolate to sirolimus, maintaining low tacrolimus levels. One month later he was admitted to our hospital for investigation of intermittently high fever, fatigue, myalgias, and diarrhea. Physical examination was unremarkable and drug levels were not increased. Lactic dehydrogenase and C-reactive protein were increased. The blood cell count and chest radiographic findings were normal. After extensive cultures, he was started on broad-spectrum antibiotics. Inflammatory markers and fever worsened, but diarrhea resolved. All serologic and imaging tests excluded infection, immunemediated diseases, and malignancy. After 12 days antibiotics were stopped as no clinical improvement was achieved. Drug fever was suspected; sirolimus was replaced by mycophenolate mofetil. Fever and other symptoms disappeared after 24 hours; inflammatory markers normalized in a few days. After 1 month the patient was in good health with stable renal function. Although infrequent, the recognition of drug fever as a potential side effect of sirolimus may avoid unnecessary invasive diagnostic procedures. Nevertheless, exclusion of other common causes of fever is essential.

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Section: Discussionmentioning

confidence: 99%

Section: S Irolimus (Sir) Is a Macrolide Derivative That Hasmentioning

confidence: 99%

Sirolimus-Induced Drug Fever in a Renal Transplant Patient: A Case Report

Aires

Carvalho

Remédio

et al. 2009

Transplantation Proceedings

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“…Despite combination therapy targeted at gram-negative microorganisms being common clinical practice, there is presently no evidence to suggest that combination therapy has any benefit over monotherapy in patients with VAP or other forms of nosocomial pneumonia (282)(283)(284).…”

Section: Treatment Based On Knowledge Of the Etiologic Microorganismmentioning

confidence: 99%

Infectious Diseases in Critical Care Medicine

2009

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“…To our knowledge, this is the first reported case of drug-fever obviously related to sirolimus. Two years ago, Dorschner et al [18] described a 2-year drug-related fever caused by everolimus, a sirolimusderived immunosuppressant (Certican ® ). Their patient was 66 years old and received a cardiac transplant due to dilatative cardiomyopathy.…”

Section: Developed Seizures (Status Epilepticus Occurred In Two Patiementioning

confidence: 99%

Sirolimus-induced drug fever and ciclosporin-induced leukencephalopathia with seizures in one liver transplant recipient

Schacherer¹,

Zeitoun²,

Büttner³

et al. 2007

WJG

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We describe the first case of sirolimus-induced drug fever in a female liver transplant recipient, with a history of hepatitis C-induced end-stage liver cirrhosis in 1999. In 2005, six years after transplantation, she developed calcineurin inhibitor-induced renal function impairment. Immunosuppression was switched from tacrolimus to sirolimus. Two days after the intake of sirolimus, she developed daily fever spikes, but no infectious focus was found. Antibiotic therapy had no influence on the fever. After fourteen days, sirolimus was switched back to tacrolimus and the fever disappeared. In history, the patient developed ciclosporin-induced generalized seizures eleven days after liver transplantation, followed by the development of a motoric speech disorder. Magnetic resonance imaging (MRI) findings were consistent with leucoencephalopathy, therefore i m m u n o s u p p r e s s i v e t h e r a p y w a s c h a n g e d f r o m ciclosporin to tacrolimus and the neurologic symptoms improved significantly. Our case is the first reported case of sirolimus-induced drug fever. In addition, the patient showed the rare occurrence of ciclosporin-induced leukencephalopathy with seizures.

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Everolimus-Induced Drug Fever After Heart Transplantation

Cited by 3 publications

References 0 publications

Sirolimus-Induced Drug Fever in a Renal Transplant Patient: A Case Report

Sirolimus-Induced Drug Fever in a Renal Transplant Patient: A Case Report

Infectious Diseases in Critical Care Medicine

Sirolimus-induced drug fever and ciclosporin-induced leukencephalopathia with seizures in one liver transplant recipient

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