Successful treatment of subungual fibromas of tuberous sclerosis with topical rapamycin.

atemporal relationshipbetweeninitiationofthedrugandsymptomsof edema (that can vary froma fewmonths to years)may suggest this association.4 The anatomical correlation between lymphedemaandthesiteofprevious surgery (or theareaof the AVFused for hemodialysis)may be explained because trauma to local lymphaticsbyprevioussurgerycancausefailureof lymphangiogenesis as apart ofwoundhealing. Themechanismby which sirolimus interfereswith lymphatic drainage is unclear, butithasbeenpostulatedthatuseaftersurgeryinhibitslymphangiogenesis, prevents lymphatic endothelial cellmigration, and causeslymphaticendothelialcellproliferation. Interferencewith lymphatic integrity has also been hypothesized.5 In conclusion, we describe herein 2 renal transplant patients with chronic lymphedema attributable to sirolimus at the sameareawhere theAVF forhemodialysiswas located.Patients taking inhibitors of mTOR should be carefully monitored for this complication at an early stage, so that dose reduction or discontinuation of treatment might prevent an irreversible lymphedema.