Case Report
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2007; 13(45): 6090-6093
Published online Dec 7, 2007. doi: 10.3748/wjg.v13.i45.6090
Sirolimus-induced drug fever and ciclosporin-induced leukencephalopathia with seizures in one liver transplant recipient
Doris Schacherer, Martina Zeitoun, Roland Büttner, Cornelia Gelbmann, Aiman Obed, Hans-Jürgen Schlitt, Jürgen Schölmerich, Gabi I Kirchner
Doris Schacherer, Martina Zeitoun, Roland Büttner, Cornelia Gelbmann, Jürgen Schölmerich, Gabi I Kirchner, Department of Internal MedicineI, University of Regensburg, Regensburg 93042, Germany
Aiman Obed, Hans-Jürgen Schlitt, Department of Surgery, University of Regensburg, Regensburg 93042, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Doris Schacherer, Klinik und Poliklinik für Innere MedizinI, Universitätsklinikum, Regensburg 93042, Germany.
Telephone: +49-941-9447001 Fax: +49-941-9447002
Received: July 12, 2007
Revised: August 8, 2007
Accepted: October 8, 2007
Published online: December 7, 2007

We describe the first case of sirolimus-induced drug fever in a female liver transplant recipient, with a history of hepatitis C-induced end-stage liver cirrhosis in 1999. In 2005, six years after transplantation, she developed calcineurin inhibitor-induced renal function impairment. Immunosuppression was switched from tacrolimus to sirolimus. Two days after the intake of sirolimus, she developed daily fever spikes, but no infectious focus was found. Antibiotic therapy had no influence on the fever. After fourteen days, sirolimus was switched back to tacrolimus and the fever disappeared. In history, the patient developed ciclosporin-induced generalized seizures eleven days after liver transplantation, followed by the development of a motoric speech disorder. Magnetic resonance imaging (MRI) findings were consistent with leucoencephalopathy, therefore immunosuppressive therapy was changed from ciclosporin to tacrolimus and the neurologic symptoms improved significantly. Our case is the first reported case of sirolimus-induced drug fever. In addition, the patient showed the rare occurrence of ciclosporin-induced leukencephalopathy with seizures.

Keywords: Liver transplantation, Immunosuppression, Side effects