Severe Hypertriglyceridemia Induced by Sirolimus Treated With Medical Management Without Plasmapheresis: A Case Report

Summary: Hypertriglyceridemia and hyperlipidemia are the most remarkable metabolic complications seen with long-term sirolimus therapy. We report the case of a 36-year-old woman status post bilateral lung transplantation on a maintenance immunosuppression regimen of sirolimus, tacrolimus, and prednisone who presented with status migrainosus, chest pain, abdominal discomfort, and triglyceride levels greater than 4425 mg/dL. In previously reported cases of severe hypertriglyceridemia that developed on maintenance sirolimus therapy, plasmapheresis has been utilized as an early strategy to rapidly lower triglycerides in order to minimize the risk of acute complications such as pancreatitis, but our case was managed medically without plasmapheresis. The most recent triglyceride was down to 520 mg/dL 2 months after discontinuation of sirolimus. We estimate the probability of this reaction to sirolimus as probable based on a score of 5 points on the Naranjo scale. This is the first case report to our knowledge that highlights the sole use of oral lipid-lowering drug agents to treat severe hypertriglyceridemia secondary to sirolimus without the use of plasmapheresis. Conclusion: Sirolimus-induced severe hypertriglyceridemia can be managed with oral lipid-lowering agents without plasmapheresis. Clinician needs to be aware of the importance of baseline and regular triglyceride monitoring in patients on sirolimus.

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Posterior reversible encephalopathy syndrome with cortical blindness at normal therapeutic levels of cyclosporine following bilateral lung transplantation - a case report

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269258 ◽

2011 ◽

Vol 59 (S 01) ◽

Cited By ~ 1

Author(s):

O Deutsch ◽

T Deuse ◽

H Treede ◽

F Wagner ◽

B Sill ◽

...

Keyword(s):

Case Report ◽

Lung Transplantation ◽

Posterior Reversible Encephalopathy Syndrome ◽

Cortical Blindness ◽

Posterior Reversible Encephalopathy ◽

Bilateral Lung Transplantation ◽

Bilateral Lung ◽

Reversible Encephalopathy

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Anaesthetic challenges in pulmonary alveolar microlithiasis – a rare disease treated with bilateral lung transplantation, first case from India

Annals of Cardiac Anaesthesia ◽

10.4103/aca.aca_165_19 ◽

2021 ◽

Vol 24 (1) ◽

pp. 79

Author(s):

Pradeep Kumar ◽

Apar Jindal ◽

Prabhat Dutta ◽

Sandeep Attawar ◽

Vijil Rahulan

Keyword(s):

Lung Transplantation ◽

Rare Disease ◽

Pulmonary Alveolar Microlithiasis ◽

Bilateral Lung Transplantation ◽

First Case ◽

Bilateral Lung ◽

Alveolar Microlithiasis

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Lipid disorders in pregnancy

Current Pharmaceutical Design ◽

10.2174/1381612827666210421103245 ◽

2021 ◽

Vol 27 ◽

Author(s):

Anastasios Liberis ◽

Stamatis Petousis ◽

Panagiotis Tsikouras

Keyword(s):

Pregnant Women ◽

Low Density Lipoprotein ◽

Safety Data ◽

Density Lipoprotein ◽

Lipid Lowering ◽

Lipid Disorders ◽

Severe Hypertriglyceridemia ◽

History Of ◽

Lipid Lowering Agents ◽

In Pregnancy

: Dyslipidemia represents a major risk factor for cardiovascular disease. In addition, severe hypertriglyceridemia is an important cause of acute pancreatitis. Accordingly, the increase in serum lipid levels that are observed during pregnancy have potentially important implications. The management of dyslipidemia in pregnancy is further complicated by the lack of safety data during this period for most of the lipid-lowering agents. In the present review, we discuss the most important lipid disorders in pregnant women and their management. Pregnancy is characterized by increases in both low-density lipoprotein cholesterol (LDL-C) and triglyceride levels, which might result in severe complications both for the mother and the fetus. Accordingly, LDL-C and triglyceride levels should be monitored during pregnancy, particularly in women with a history of dyslipidemia. Diet is the mainstay of management of dyslipidemia in pregnant women and apheresis can also be considered in patients with homozygous familial hypercholesterolemia or severe hypertriglyceridemia. However, there is a pressing need for studies that with evaluate the safety of lipid-lowering agents during pregnancy.

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Xanthoma disseminatum treated with lipid-lowering agents: A case report and review of the literature

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2015.02.013 ◽

2015 ◽

Vol 72 (5) ◽

pp. AB1 ◽

Cited By ~ 1

Keyword(s):

Case Report ◽

Lipid Lowering ◽

Review Of The Literature ◽

Lipid Lowering Agents ◽

Xanthoma Disseminatum

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New-onset asthma in a bilateral lung transplant patient

BMJ Case Reports ◽

10.1136/bcr-2019-231654 ◽

2019 ◽

Vol 12 (11) ◽

pp. e231654

Author(s):

Daniel Benjamin Fyenbo ◽

Kristine Bruun Degn ◽

Johannes Martin Schmid ◽

Elisabeth Bendstrup

Keyword(s):

Lung Transplant ◽

Inhaled Corticosteroids ◽

Challenge Test ◽

Bilateral Lung Transplantation ◽

Beta Agonists ◽

First Case ◽

Bilateral Lung ◽

Long Acting ◽

Severe Airway Obstruction ◽

New Onset

We present a case of new-onset asthma in a 35-year-old man who had undergone bilateral lung transplantation 11 years before due to idiopathic bronchiectasis and pulmonary hypertension. He presented with recurrent episodes of breathlessness, wheezing and coughing. Spirometry demonstrated severe airway obstruction. After treatment with systemic and inhaled corticosteroids and long-acting bronchodilators as well as short-acting beta-agonists as needed, his symptoms resolved and his spirometry normalised. A bronchial mannitol challenge test showed significant airway hyperresponsiveness and is thus consistent for a diagnosis of asthma. To our best knowledge, this is the first case of late new-onset asthma in a lung transplant recipient.

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