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Abstract

The mammalian target of rapamycin inhibitor siro limus was introduced into clinical transplant practice in 1999. Dose-related myelosuppression and hyper lipidemia are the most common adverse effects. Pulmonary toxicity has been reported since 2004 and can cause interstitial pneumonitis, organizing pneu monia, and alveolar hemorrhage. Moreover, it can occasionally induce posterior reversible encep halopathy syndrome, as documented in scarce reports. To our knowledge; this is the 1st report of combined posterior reversible encephalopathy syndrome and lymphocytic pneumonitis to be induced by sirolimus. Here, we present a renal transplant recipient with reversible sirolimusinduced brain lesions who was diagnosed after exclusion of infections (viral, bacterial, and fungal), tumors, sarcoidosis, and autoimmune disorders. Both brain lesions and pneumonitis resolved completely after sirolimus discontinuation with excellent patient and graft outcome. Early and gradual sirolimus withdrawal can reverse posterior reversible encephalopathy syndrome and lymphocytic pneumonitis with preservation of stable graft function.

ADEM post-Sars-CoV-2 infection in a pediatric patient with Fisher-Evans syndrome

“…In the available literature, there are no cases of ADEM associated with sirolimus or thalidomide therapy. However, only one case of posterior reversible encephalopathy syndrome (PRES) has been described in a patient with sirolimus-induced brain lesions [ 9 ]. In our patient, the pathogenetic hypothesis of PRES was excluded after performing brain MRI.…”

Neurotoxicity of Paclitaxel and Rapamycin in a Rat Model with Transient Blood-Brain Barrier Opening

“…Rapamycin- related complications mainly include myelosuppression and hyperlipidemia. Although rapamycin easily crosses the BBB, neurotoxicity has not been reported except in five cases of posterior reversible encephalopathy, which was suspected to be caused by rapamycin-related neurotoxicity simply based on recovery after rapamycin discontinuation [ 5 , 11 ]. Therefore, even though our experiment did not show high-dose rapamycininduced neurotoxicity in a rat model, using rapamycin-coated devices needs to be avoided until the adverse effects in humans are clearly shown.…”

“…Drug-eluting stents (DESs) and drug-eluting balloons (DEBs) in the coronary system, which release drugs that inhibit intimal hyperplasia, have also been used for ICAS with good preliminary results in reducing restenosis [ 1 , 2 , 6 , 7 , 9 , 10 , 12 , 13 , 16 ]. However, applying these drugs to cerebral arteries may provoke neurotoxicity [ 2 , 5 , 12 ].…”