Abstract
A 59-year-old man who had undergone cadaveric renal transplantation received immunosuppression therapy with azathiopurine, predonisolone, and tacrolimus for 9 months. The patient complained of dry cough and dyspnea with fever when he saw a doctor and he was hospitalized after wasting one week. A computed tomography showed mild interstitial pneumonia. The patient was tentatively diagnosed as opportunistic infection in a compromized host and treated in empirical way, but he died 4 weeks after admission without any response to our treatment. All of the laboratory tests and pathological findings could not indicate the evidence of any opportunistic infections in the lungs. Azathioprine-induced interstitial pneumonia was a rare complication but a total dose of azathioprine of our patient (15, 750mg) was as much enough as to induce interstitial pneumonia and histologocal findings in autopsy specimen that were usual interstitial pneumonia and diffuse alveolar damage strongly suggested the toxic effects of azathioprine. On the management of respiratory failure in an immunosuppressed host, we should keep in mind azathioprine-induced interstitial pneumonia as well as opportunistic infections.
