Case Report

Tacrolimus-induced lung injury in a rheumatoid arthritis patient with interstitial pneumonitis

Authors

Yusuke Miwa¹, Takeo Isozaki¹, Kuninobu Wakabayashi¹, Tsuyoshi Odai¹, Mizuho Matsunawa¹, Nobuyuki Yajima¹, Masao Negishi¹, Hirotsugu Ide¹, Tsuyoshi Kasama¹, Mitsuru Adachi¹, Tomoyuki Hisayuki² and Tamiko Takemura³

1. Division of Rheumatology and Clinical Immunology, First Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-0064, Japan
2. First Department of Pathology, Showa University School of Medicine, Tokyo, Japan
3. Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan

Received:

4 July 2007

Accepted:

14 November 2007

Published online:

29 February 2008

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Abstract

A 74-year-old woman was experiencing rheumatoid arthritis complicated with interstitial pneumonitis (IP), and tacrolimus treatment was started. She presented with dyspnea. Chest X-ray and computed tomography (CT) showed ground-glass opacity and IP. Although tacrolimus was stopped, she died of respiratory failure. At autopsy, both the upper and lower lung fields showed usual IP and the organizing stage of diffuse alveolar damage. The former is common, but the latter is uncommon, suggesting tacrolimus may cause severe alveolar damage.

Keywords

Rheumatoid arthritis - Tacrolimus - Interstitial pneumonitis