TACROLIMUS-INDUCED LUNG INJURY

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Tacrolimus is commonly used for immunosuppression after solid-organ transplant to prevent organ rejection. has a wide range of adverse effects, including secondary infections, renal failure, hyperglycemia, and weight gain, when in combination with other medications. However, association diffuse lung disease quite rare. We present case injury associated tacrolimus. CASE PRESENTATION: A 56-year-old Caucasian man past medical history hypertension, diabetes, morbid obesity, on tacrolimus mycophenolate, localized cell carcinoma nephrectomy was transferred our institution evaluation suspected non-small cancer (NSCLC). few weeks prior the current presentation, patient diagnosed treated community-acquired pneumonia oral antibiotics. Follow-up imaging, CT Chest subsequent PET CT, revealed interstitial changes multiple small pulmonary nodules without increased metabolic activity concerning lymphangitic carcinomatosis or atypical infection. During became hypoxic admitted. Bronchoscopy brush biopsy BAL demonstrated cells NSCLC, further evaluation. Due inconclusive pathology report from bronchoscopy, persistent hypoxia, dyspnea exertion, underwent repeat bronchoscopy endobronchial ultrasound-guided biopsy, BAL, trans-bronchial biopsies, which negative malignancy. Extensive microbiologic workup viral, bacterial, fungal organisms remained negative. differential showed significant eosinophilia 15%, transbronchial acute chronic inflammation. Drug toxicity presumed be primary culprit. The started prednisone therapy discharged. On outpatient follow-up six later, had resolution dyspnea, imaging complete opacities. discontinued indefinitely. DISCUSSION: solid transplantation rare previously described series rheumatoid arthritis patients. To best knowledge, this first description tacrolimus-induced CONCLUSIONS: Tacrolimus-associated disease, although rare, should considered patients presenting infiltrates while therapy, appropriate work up exclude infections. REFERENCE #1: M. Schwaiblmair, W. Behr, T. Haeckel, B. Markl, Foerg, Berghaus, "Drug induced instertial disease," Open Respiratory Medicine Journal, vol. 6, no. 1, pp. 63-74, 2012 #2: Allen JN, Davis WB, Pacht ER. "Diagnostic significance bronchoalveolar lavage fluid eosinophils." Am Rev Respir Dis. 1990 Sept;142(3):642-7, doi:10.1164/ajrccm/142.3.642. PMID: 2389917. #3: Koike R, Tanaka M, Komano Y, Sakai F, Sugiyama H, Nanki T, Ide Jodo S, Katayama K, Matsushima Miwa Y. Tacrolimus-induced Pulmonary pharmacology & therapeutics. 2011 Aug 1;24(4):401-6. DISCLOSURES: No relevant relationships by Sarenthia Epps, source=Web Response no disclosure file Anand Venkata