Caso Clínico\Clinical Case
Toxicidade pulmonar induzida pela rapamicina
Lung toxicity induced by rapamycin
1 Interna complementar de Pneumologia, Hospital de São João, Serviço de Pneumologia, Porto (EPE)
2 Interna complementar de Nefrologia, Faculdade de Medicina da Universidade do Porto
3 Assistente hospitalar de Pneumologia, Hospital de São João (EPE), Serviço de Pneumologia, Alameda Hernâni Monteiro, 4200 – Porto
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"apellidos" => "Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Morais" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "af0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Interna complementar de Pneumologia, Hospital de São João, Serviço de Pneumologia, Porto (EPE)" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Interna complementar de Nefrologia, Faculdade de Medicina da Universidade do Porto" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Assistente hospitalar de Pneumologia, Hospital de São João (EPE), Serviço de Pneumologia, Alameda Hernâni Monteiro, 4200 – Porto" "etiqueta" => "3" "identificador" => "af0015" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Lung toxicity induced by rapamycin" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-06-02" "fechaAceptado" => "2006-07-11" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec568007" "palabras" => array:3 [ 0 => "Sirolimus" 1 => "toxicidade pulmonar" 2 => "lavado broncoalveolar" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec568006" "palabras" => array:3 [ 0 => "Sirolimus" 1 => "lung toxicity" 2 => "bronchoalveolar lavage" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">As doenças pulmonares induzidas por fármacos constituem uma causa crescente de morbilidade, tendo sido descritas diferentes formas de toxicidade associadas a inúmeras substâncias. O sirolimus (rapamicina) é um fármaco imunossupressor usado de forma crescente no contexto do transplante de órgãos sólidos, nomeadamente no transplante renal. A toxicidade pulmonar tem sido descrita como um dos potenciais efeitos laterais, nomeadamente causando formas de pneumonite intersticial ou, mais raramente, hemorragia alveolar. Os autores descrevem os casos de quatro doentes (3 do sexo masculino, 1 do sexo feminino) com idades compreendidas entre os 46-71 anos, recipientes de transplante renal (rim cadáver) há 3 anos (1 doente) e 7 anos (3 doentes). A imunosupressão consistia em micofenolato mofetil, prednisolona e rapamicina. Os quarto doentes foram admitidos por febre, tosse produtiva (2) e dispneia (3). Apresentavam imagem radiológica de infiltrados pulmonares bilaterais de predomínio basal. O LBA mostrou alveolite linfocítica em 3 doentes, tendo-se observado no entanto diferentes relações CD4/CD8., para além de neutrofilia em 2 deles. No restante doente, observou-se hemorragia alveolar grave. Não houve em nenhum dos casos qualquer isolamento de micro organismos patogénicos no LBA. As queixas apresentadas, bem como as alterações radiológicas regrediram com a suspensão do fármaco. Estes quatro casos revelaram alguma variedade, quer na apresentação clínica, quer nos achados dos exames subsidiários efectuados, nomeadamente no LBA. Este facto pode ter como causa diferentes mecanismos fisiopatológicos a nível do pulmão induzidos pelo sirolimus.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2006; XII (6): 715-724</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Drug induced lung diseases (DILD) are an increasingly cause of morbidity. Many drugs have been described, causing several patterns of injury. Sirolimus is an immunosuppressive agent increasingly used in renal and other solid organ transplantation. Pulmonary toxicity has been recognised as a potential complication associated to this medication. Interstitial pneumonitis and more rarely alveolar haemorrhage have been described. The authors describe 4 cases (3 men and 1 woman) between 46-71 years, transplanted three years ago (1 patient) and 7 years ago (3 patients). All of them were medicated with micofenolato mofetil, prednisone and sirolimus. All patients had fever at admission, 3 patients had dyspnoea and 2 productive cough. Diffuse pulmonary infiltrates with basal predominance in HRCT scan were present in the four patients. BAL showed lymphocytic alveolitis in 3 cases, however with a different CD4/CD8 ratio. In additio to lymphocytosis, neutrophilia was observed in 2 patients. One patient showed serious alveolar haemorrhage in BAL. Pulmonary infections were ruled out by specific BAL staining and cultures. After drug suspension, all patients showed a clear improvement. These case studies show some diversity in clinical presentation and in the features of some exams, namely in BAL. This may suggest different underlying pathophysiology entities induced by sirolimus.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2006; XII (6): 715-724</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Vlahakis" 1 => "B. Rickman" 2 => "T. Morgenthaler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/79.4.541" "Revista" => array:6 [ "tituloSerie" => "SirolimusAssociated Diffuse Alveolar Hemorrhage Mayo Clin Proc" "fecha" => "2004" "volumen" => "79" "paginaInicial" => "541" "paginaFinal" => "545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15065619" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bb0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway anastomotic dehiscence associated with use of sirolimus immediately after lung transplantation Airway anastomotic dehiscence associated with use of sirolimus immediately after lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.B. King-Biggs" 1 => "J.M. Dunitz" 2 => "S.J. Park" 3 => "S. Kay Savik" 4 => "M.I. Hertz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.TP.0000064083.02120.2C" "Revista" => array:7 [ "tituloSerie" => "Transplantation" "fecha" => "2003" "volumen" => "75" "numero" => "9" "paginaInicial" => "1437" "paginaFinal" => "1443" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12792493" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bb0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway anastomosis complications in de novo lung transplantation with sirolimus-based immunosupression" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "J. Groetzner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1053-2498(03)00309-7" "Revista" => array:7 [ "tituloSerie" => "J. Heart Lung Transplant" "fecha" => "2004" "volumen" => "23" "numero" => "5" "paginaInicial" => "632" "paginaFinal" => "638" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15135383" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bb0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.R. Hachem" 1 => "M.M. Chakinala" 2 => "A.A. Aloush" 3 => "G.A. Patterson" 4 => "E.P. Trulock" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Thrombotic microangiopathy after lung transplantation Transplantation" "fecha" => "2006" "volumen" => "81" "numero" => "1" "paginaInicial" => "57" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16421477" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bb0025" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patterns of Pulmonary Complications associated with sirolimus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.N. Chhajed" 1 => "M. Dickenmann" 2 => "L. Bubendorf" 3 => "M. Mayr" 4 => "J. Steiger" 5 => "M. 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intersticial Pneumonitis associated with sirolimus therapy in renal-transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Morelion" 1 => "M. Stern" 2 => "H. Kreis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med" "fecha" => "2000" "volumen" => "343" "paginaInicial" => "225" "paginaFinal" => "226" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bb0055" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of sirolimus-associated intersticial pneumonitis in renal transplant patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "E. Morelion" 1 => "M. Stern" 2 => "D. Israel-Biet" 3 => "J.M. 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Travis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1043/0003-9985(2002)126<1064:AFAOP>2.0.CO;2" "Revista" => array:7 [ "tituloSerie" => "Archives of Pathology and Laboratory Medicine" "fecha" => "2002" "volumen" => "126" "numero" => "9" "paginaInicial" => "1064" "paginaFinal" => "1070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12204055" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bb0065" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Sirolimus drug information. <a href="http://vaww.pbm.med.va.gov">http://vaww.pbm.med.va.gov</a>." ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "pt" "url" => "/08732159/0000001200000006/v1_201509071353/S0873215915304633/v1_201509071353/pt/main.assets" "Apartado" => array:4 [ "identificador" => "43381" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos Clínicos/Clinical Cases" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001200000006/v1_201509071353/S0873215915304633/v1_201509071353/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915304633?idApp=UINPBA00004E" ]
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ISSN: 08732159Original language: Portuguese
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| 2023 April | 70 | 17 | 87 |
| 2023 March | 43 | 31 | 74 |
| 2023 February | 25 | 16 | 41 |
| 2023 January | 38 | 16 | 54 |
| 2022 December | 30 | 21 | 51 |
| 2022 November | 42 | 23 | 65 |
| 2022 October | 37 | 26 | 63 |
| 2022 September | 25 | 29 | 54 |
| 2022 August | 41 | 51 | 92 |
| 2022 July | 30 | 28 | 58 |
| 2022 June | 27 | 29 | 56 |
| 2022 May | 44 | 27 | 71 |
| 2022 April | 25 | 15 | 40 |
| 2022 March | 22 | 30 | 52 |
| 2022 February | 26 | 24 | 50 |
| 2022 January | 26 | 36 | 62 |
| 2021 December | 26 | 31 | 57 |
| 2021 November | 30 | 27 | 57 |
| 2021 October | 20 | 32 | 52 |
| 2021 September | 24 | 30 | 54 |
| 2021 August | 29 | 20 | 49 |
| 2021 July | 18 | 26 | 44 |
| 2021 June | 25 | 25 | 50 |
| 2021 May | 36 | 23 | 59 |
| 2021 April | 29 | 25 | 54 |
| 2021 March | 43 | 20 | 63 |
| 2021 February | 36 | 19 | 55 |
| 2021 January | 32 | 13 | 45 |
| 2020 December | 35 | 11 | 46 |
| 2020 November | 31 | 16 | 47 |
| 2020 October | 33 | 15 | 48 |
| 2020 September | 52 | 28 | 80 |
| 2020 August | 33 | 20 | 53 |
| 2020 July | 54 | 11 | 65 |
| 2020 June | 39 | 17 | 56 |
| 2020 May | 47 | 15 | 62 |
| 2020 April | 62 | 21 | 83 |
| 2020 March | 42 | 11 | 53 |
| 2020 February | 44 | 19 | 63 |
| 2020 January | 47 | 17 | 64 |
| 2019 December | 35 | 18 | 53 |
| 2019 November | 42 | 13 | 55 |
| 2019 October | 50 | 19 | 69 |
| 2019 September | 37 | 19 | 56 |
| 2019 August | 63 | 24 | 87 |
| 2019 July | 30 | 15 | 45 |
| 2019 June | 32 | 15 | 47 |
| 2019 May | 52 | 24 | 76 |
| 2019 April | 38 | 29 | 67 |
| 2019 March | 46 | 14 | 60 |
| 2019 February | 52 | 19 | 71 |
| 2019 January | 48 | 13 | 61 |
| 2018 December | 12 | 10 | 22 |
| 2018 November | 11 | 0 | 11 |
| 2018 October | 11 | 0 | 11 |
| 2018 September | 10 | 13 | 23 |
| 2018 August | 41 | 25 | 66 |
| 2018 July | 34 | 20 | 54 |
| 2018 June | 55 | 19 | 74 |
| 2018 May | 50 | 18 | 68 |
| 2018 April | 41 | 30 | 71 |
| 2018 March | 40 | 23 | 63 |
| 2018 February | 12 | 14 | 26 |
| 2018 January | 30 | 13 | 43 |
| 2017 December | 26 | 13 | 39 |
| 2017 November | 31 | 13 | 44 |
| 2017 October | 21 | 15 | 36 |
| 2017 September | 32 | 14 | 46 |
| 2017 August | 28 | 12 | 40 |
| 2017 July | 27 | 5 | 32 |
| 2017 June | 27 | 11 | 38 |
| 2017 May | 41 | 15 | 56 |
| 2017 April | 17 | 14 | 31 |
| 2017 March | 18 | 35 | 53 |
| 2017 February | 12 | 4 | 16 |
| 2017 January | 11 | 7 | 18 |
| 2016 December | 13 | 7 | 20 |
| 2016 November | 7 | 8 | 15 |
| 2016 October | 13 | 7 | 20 |
| 2016 September | 2 | 6 | 8 |
| 2016 August | 3 | 2 | 5 |
| 2016 July | 3 | 5 | 8 |
| 2016 June | 3 | 0 | 3 |
| 2016 May | 0 | 5 | 5 |
| 2016 April | 4 | 4 | 8 |
| 2016 March | 1 | 3 | 4 |
| 2016 February | 2 | 12 | 14 |
| 2016 January | 10 | 2 | 12 |
| 2015 December | 4 | 2 | 6 |
| 2015 November | 1 | 2 | 3 |
| 2015 October | 2 | 2 | 4 |
Show all
