[Drug-induced pneumonitis due to sirolimus: an interaction with atorvastatin?]. / Pneumopathie médicamenteuse sous sirolimus: interaction avec l'atorvastatine?

INTRODUCTION: Sirolimus is an immunosupressant used in renal transplantation because of its lack of nephrotoxicity. We report four cases of pneumonitis due to sirolimus, possibly revealing an interaction with atorvastatin. CASE REPORT: Four patients (previously on long-term treatment with atorvastatin) presented with respiratory symptoms between 3 and 56 months after starting treatment with sirolimus following renal transplantation. Thoracic CT scans showed bilateral areas of peripheral alveolar consolidation. Bronchial lavage showed a lymphocytic alveolitis. Open-lung biopsy showed organizing pneumonia associated with diffuse alveolar damage and caseating granulomata. We attributed the pneumonitis to sirolimus on account of clinical and radiological resolution within 1 to 6 months of stopping treatment. We raise the possibility of an association between sirolimus and atorvastatin by competition for their hepatic degradation pathway via cytochrome P450 3A4. CONCLUSION: Sirolimus causes drug-induced pneumonitis that is predominantly an organizing pneumonia. Atorvastatin may encourage its development by competition with sirolimus in the liver.

[Pulmonary infection from Rhodococcus equi after renal transplantation. Review of the literature]. / Infection pulmonaire à Rhodococcus equi après transplantation rénale. Revue de la littérature.

Rhodococcus Equi, a strictly aerobic Gram positive coco-bacillus, is a pathogen for horses and foals. It may induce opportunistic infections and is described in AIDS infected patients. We report the case of a 47-year old man, breeder of horses, with kidney transplant who has presented, 8 years after his graft, an impairment of health, a fever and evidence of pulmonary disease. The pulmonary biopsy under scanner guidance and microbiology study, has displayed the diagnosis of Rhodococcus equi infection. The evolution has been favorable with double antibiotherapy (follow-up 27 months). Ten comparable observations have been published after organ transplantation: (kidney: 8; heart: 1; liver: 1). Pulmonary locations are widely predominant. The animal contact is found only in 30% of cases. The presentation of the sickness has been compared to pulmonary tuberculosis or to nocardiosis, pathologies often observed in this context of immunosuppression. The antibiotic treatment is difficult and should required two bactericidal antibiotics. A surgical lobectomy can be envisaged in case of relapse. The mortality is 30%.

[Extra-capillary proliferation complicating the development of an extramembranous idiopathic glomerulonephritis]. / Prolifération extra-capillaire compliquant l'évolution d'une glomérulonéphrite extra-membraneuse idiopathique.

Occurrence of crescentic formation superimposed to idiopathic membranous glomerulopathy worsens severely its prognosis with evolution to end stage renal disease. We report the case of a 65 years old man with nephrotic idiopathic membranous glomerulopathy who subsequently developed an acute renal failure secondary to crescentic formation. Pulse of high dose methylprednisolone administration improved renal function. Seven similar observations are analysed and pathogenic mechanisms discussed.

[Late onset cystinosis. Apropos of a case]. / Cystinose de révélation tardive--a propos d'une observation.

This report concerns a new case of late onset cystinosis with heavy proteinuria. Renal biopsy showed focal segmental glomerular hyalinosis and the usual tubular and glomerular lesions of cystinosis. The pathogenesis of glomerular hyalinosis remains unclear.

[Overload histiocytosis in 2 hemodialyzed patients. Possible role of dextran 40]. / Histiocytose de surcharge chez deux hémodialysés. Rôle possible du dextran 40.

The authors report two cases of singular overloading histiocytosis, observed in patients treated with regular dialysis and undergoing feverish cachectic disease. The observations of the two patients show a same histiocytosis infiltration of ganglions, liver, muscles, lung, pleura and pericardium, consisting in an accumulation of PAS positive intracytoplasmic substance, refringent at polarisation, microcrystalline on electron microscopy and on ionic analysis. Clinical likeness appears with PVP thesaurismosis but the histochemical findings are different. A favorable issue occurred with corticosteroïd treatment. Nature of PAS positive substance is uncertain. An exogenous origin is undoubted, and some elements call for the responsibility of dextran 40.