Abstract
We describe two autopsy cases of tacrolimus-induced acute interstitial pneumonia.
Case 1: A 70-year-old woman with RA had been treated with prednisolone since 1972. In May 2007, we added tacrolimus 1.5 mg/day, however, she complained of shortness of breath in August 2007. Chest X-ray and CT scans showed bilateral ground-glass opacity in the lung fields, and acute interstitial pneumonia was diagnosed. We treated her with methylprednisolone pulse therapy, however, she died of respiratory failure. The autopsy revealed acute and organizing diffuse alveolar damage.
Case 2: A 71 year-old woman with RA had been treated with prednisolone since 2005. She developed interstitial pneumonia in 2007, and we started tacrolimus 1 mg/day in March 2008. In May, 2008 she complained of shortness of breath. Chest X-ray and CT scans showed aggravation of interstitial pneumonia. We treated her with methylprednisolone pulse therapy, however, she died of respiratory failure. The autopsy also revealed acute and organizing diffuse alveolar damage.
In both cases, implication of tacrolimus in the pathogenesis of IP was suggested.
Tacrolimus is often used for the treatment of rheumatoid arthritis, however, attention needs to be given for the onset/aggravation of acute interstitial pneumonia.
