Successful Sirolimus Treatment of Kaposi’s Sarcoma in Multiple Pulmonary Nodules
신장이식 후 피부나 림프샘 병변 없이 다발성 폐결절 형태로 발생한 카포시육종의 치료 후 호전 사례
김, 시연; 이, 효정; 정, 윤정; 신, 승수; 이, 종훈; 오, 창권
Taehan Isik Hakhoe chi, 26(4):299-304, 2012
Taehan Isik Hakhoe chi; The journal of the Korean Transplantation Society; Journal of the Korean Society for Transplantation; 대한이식학회지
Kaposi`s sarcoma is one of the most serious complications associated with immune suppression treatment after kidney transplantation. Because it usually manifestations as skin lesions or lymphadenopathies, its clinical suspicion and tissue diagnosis is relatively easy. However, Kaposi`s sarcoma presented as multiple pulmonary nodules without skin manifestations is not easily detected early and usually has a deadly prognosis. We present the case of a 36-year-old male who underwent kidney transplantation 13 months ago and has been on tacrolimus and mycophenolate mofetil (MMF)-based immune suppression presented dry cough, blood tinged sputum, and multiple pulmonary nodules without any skin lesions. Both bronchoscopic washing cytology and fine needle aspiration cytology of peripheral lung tissues were performed but failed due to low cellular yields. A video-assisted thoracoscopic biopsy subsequently revealed Kaposi`s sarcoma. Following the diagnosis, we changed the immune suppression from a tacrolimus and MMF-based regimen to a sirolimus-based regimen. Respiratory symptoms gradually disappeared and we found complete remission on follow-up radiologic evaluations. Thus sirolimus may be the preferred method of treatment for patients with immune suppression after kidney transplantation.
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