The use of proliferative signal inhibitors (PSIs) in immunosuppression-related
malignancies opens new roads for increasing the survival and quality of life in patients with solid
organ transplantation. A 56-year-old female recipient of a living donor renal allograft (1990), who was immunosuppressed with
cyclosporine (
CsA; Neoral),
azathioprine, and
steroids, did initially well with acceptable renal function. During the last 5 years she required local
therapy due to posterior vaginal lip human papillomavirus (HPV) lesions. In 2000, she discontinued
azathioprine and the CsA doses were reduced to 100 mg daily. The local lesion showed a good response to reduced immunosuppression. In February 2005, the lesion reappeared and a biopsy showed
malignancy. Local surgery was performed and CsA was replaced by
everolimus (EVL;
Certican). Two months
after treatment initiation, the patient developed
cough,
dyspnea, and low-grade
fever. Chest X-ray showed a lesion at the base of the left lung compatible with
pneumonitis. After fiberbronchoscopy a diagnosis of
bronchiolitis obliterans organizing pneumonia (BOOP) was obtained. She was treated with increased doses of oral
steroids. EVL was never discontinued. The radiological lesion disappeared and the
malignancy is currently in remission. In summary, a case of gynecological
cancer in a renal transplant recipient was treated by surgical removal. After 1 year of immunosuppression with EVL, no recurrence has been observed. The adverse event (BOOP) was probably related to the PSI treatment and was controlled with an increased dose of
steroids without discontinuing EVL.