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Yazdalı Köylü N, Koç NS, Sancar EN, Sarınç S, Altun B. Everolimus-Related Chylothorax: A Rare Case Report. EXP CLIN TRANSPLANT 2024; 22:471-474. [PMID: 39072520 DOI: 10.6002/ect.2023.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Everolimus is an orally administered mechanistic target of rapamycin inhibitor in solid-organ transplant patients. In addition to the common adverse side effects of this treatment, such as hyperlipidemia, rash, stomatitis, anorexia, diarrhea, anemia, thrombocytopenia, and leukopenia, pulmonary toxicity is also an important adverse side effect. Although pulmonary toxicity due to everolimus has been reported mostly as pneumonitis, cases of pleural effusion due to everolimus have also been reported rarely. Chylothorax is defined as the accumulation of lymphatic fluid in the pleural space. It may develop secondary to trauma or malignancy. In this case report, we present a patient with chylothorax after everolimus treatment.
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Affiliation(s)
- Nur Yazdalı Köylü
- From the Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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2
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Vaury C, Macaire P, Goirand F, Coudert B, Guérard P, Schmitt A. Lack of everolimus diffusion in pleural fluid during pleural progression of breast cancer: A case report. J Oncol Pharm Pract 2020; 27:235-237. [PMID: 32493163 DOI: 10.1177/1078155220927771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We report here a case where no everolimus pleural diffusion was evidenced at the same time of pleural progression of a metastatic breast cancer treated with everolimus and exemestane. CASE DESCRIPTION A 69-year-old woman was diagnosed in October 2006 with stage III invasive ductal breast adenocarcinoma. After nine months of everolimus and exemestane treatment, she presented with a pleural progression. Everolimus concentration was measured in blood and in pleural fluid. Residual blood concentration was at 9.1 ng/mL, while no everolimus was observed in the pleural fluid. MANAGEMENT AND OUTCOME Due to inefficacy of everolimus in this patient, she was switched to palbociclib and fulvestrant. CONCLUSION Everolimus seems to have a poor diffusion in the pleural fluid.
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Affiliation(s)
- Célia Vaury
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | - Pauline Macaire
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | - Françoise Goirand
- Pharmacology and Toxicology Laboratory, Dijon University Hospital, Dijon, France
| | - Bruno Coudert
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon, France
| | - Pascal Guérard
- Pharmacology and Toxicology Laboratory, Dijon University Hospital, Dijon, France
| | - Antonin Schmitt
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
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Iwasaki K, Seguchi O, Mochizuki H, Kimura Y, Toda K, Kumai Y, Kuroda K, Nakajima S, Watanabe T, Yanase M, Matsumoto Y, Fukushima S, Fujita T, Kobayashi J, Fukushima N. Terminal Ileac Ulcers Mimicked Post-transplantation Lymphoproliferative Disorder in a Heart Recipient Treated With Everolimus: A Case Report. Transplant Proc 2018; 50:4053-4056. [PMID: 30577313 DOI: 10.1016/j.transproceed.2018.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized and potentially fatal complication of cardiac transplantation that commonly involves the gastrointestinal tract. Herein, we report a case of life-threatening gastrointestinal bleeding from recurrent terminal ileac ulcers mimicking PTLD in a heart recipient treated with everolimus (EVL). A 40-year-old man underwent heart transplantation for dilated cardiomyopathy 3 years prior to the current admission and was treated with tacrolimus and EVL. He was admitted to a local hospital because of fever, abdominal pain, and diarrhea. His symptoms persisted and, 3 weeks later, hematochezia occurred; thus, he was transferred to our hospital. As computed tomography and 18F-fluorodeoxyglucose positron emission tomography showed bowel-wall thickening of the terminal ileum, gastrointestinal PTLD was initially suspected. However, although colonoscopy- performed after switching EVL to mycophenolate mofetil (MMF)-showed terminal ileac ulcers, the histologic examination revealed no findings corresponding to PTLD. As EVL may delay ulcer healing, MMF was maintained for 3 months. After repeated colonoscopy showed ulcer healing, MMF was switched back to EVL for cardiac allograft vasculopathy prevention. Three weeks later, he was emergently admitted to a local hospital for life-threatening gastrointestinal bleeding from a recurrent terminal ileal ulcer, which required hemostatic forceps hemostasis. As EVL is suspected to be associated with recurrent ileal ulcers, EVL was again switched back to MMF. The ileal ulcers resolved, without recurrence in 3 months of clinical follow-up. This case demonstrates that cases of life-threatening gastrointestinal bleeding from recurrent terminal ileac ulcers can mimic PTLD in a heart recipient treated with EVL.
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Affiliation(s)
- K Iwasaki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - O Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - H Mochizuki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Y Kimura
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - K Toda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Y Kumai
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - K Kuroda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - S Nakajima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - T Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - M Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Y Matsumoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - S Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - T Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - J Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - N Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
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Kazzaz F, O’Connell OJ, Vial MR, Stewart J, Grosu HB. Everolimus-induced Chylous Effusion. Am J Respir Crit Care Med 2018; 198:120-122. [DOI: 10.1164/rccm.201707-1438im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Farah Kazzaz
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Oisin J. O’Connell
- Department of Interventional Pulmonology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Macarena R. Vial
- Department of Pulmonary Medicine, Clinica Alemana de Santiago, Santiago, Chile
| | | | - Horiana B. Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Ambagtsheer F, de Jong J, Bramer WM, Weimar W. On Patients Who Purchase Organ Transplants Abroad. Am J Transplant 2016; 16:2800-2815. [PMID: 26932422 DOI: 10.1111/ajt.13766] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/25/2023]
Abstract
The international transplant community portrays organ trade as a growing and serious crime involving large numbers of traveling patients who purchase organs. We present a systematic review about the published number of patients who purchased organs. With this information, we discuss whether the scientific literature reflects a substantial practice of organ purchase. Between 2000 and 2015, 86 studies were published. Seventy-six of these presented patients who traveled and 42 stated that the transplants were commercial. Only 11 studies reported that patients paid, and eight described to what or whom patients paid. In total, during a period of 42 years, 6002 patients have been reported to travel for transplantation. Of these, only 1238 were reported to have paid for their transplants. An additional unknown number of patients paid for their transplants in their native countries. We conclude that the scientific literature does not reflect a large number of patients buying organs. Organ purchases were more often assumed than determined. A reporting code for transplant professionals to report organ trafficking networks is a potential strategy to collect and quantify cases.
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Affiliation(s)
- F Ambagtsheer
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J de Jong
- Analysis and Research Department, Central Division of the National Police, Driebergen, the Netherlands.,Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W Weimar
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Gharbi C, Gueutin V, Izzedine H. Oedema, solid organ transplantation and mammalian target of rapamycin inhibitor/proliferation signal inhibitors (mTOR-I/PSIs). Clin Kidney J 2014; 7:115-20. [PMID: 25852858 PMCID: PMC4377777 DOI: 10.1093/ckj/sfu001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 01/16/2014] [Indexed: 11/17/2022] Open
Abstract
Mammalian target of rapamycin inhibitor (mTOR-I)/proliferation signal inhibitors (PSI) including sirolimus and everolimus represent a new class of drugs increasingly used in solid-organ transplantation as alternatives to calcineurin inhibitors for patients with renal dysfunction, transplant coronary arterial vasculopathy or malignancy. The most frequently occurring mTOR-I/PSI-related adverse events are similar to those associated with other immunosuppressive therapies, but some side effects are more characteristic of proliferation signal inhibitors (e.g. lymphocele, arthralgia, oedema and hyperlipidaemia). The present paper review incidence, clinical presentation and mechanism of oedema within the clinical experience of mTOR-I/PSI in solid organ transplantation.
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Affiliation(s)
- Chems Gharbi
- Department of Nephrology , Pitié Salpetriere Hospital , Paris , France
| | - Victor Gueutin
- Department of Nephrology , Pitié Salpetriere Hospital , Paris , France
| | - Hassan Izzedine
- Department of Nephrology , Pitié Salpetriere Hospital , Paris , France
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