We herein report a case of putative
everolimus-associated
chylothorax in a cardiac transplant recipient. A 17-year-old Japanese boy with
dilated cardiomyopathy and severe
cardiac failure requiring left ventricular assist support was determined to be a cardiac transplant candidate in 1992. He underwent overseas
heart transplantation in Houston, Texas in October 1992. He was subsequently treated with immunosuppression therapy:
Cyclosporine (CSA),
azathioprine, and
prednisolone (PRD). After several acute rejection episodes requiring
steroid therapy, intravascular ultrasonography revealed a moderate degree of transplant coronary arterial vasculopathy (TCAV) with 50%
stenosis in 2003. He underwent coronary stenting twice; the immunosuppressive regimen was converted to CSA,
mycophenolate mofetil,
everolimus (EVL), and PRD in 2006. TCAV has not progressed since then. In October 2008, chest x-ray showed bilateral
pleural effusion. As we thought that the
pleural effusion was caused by cardiac dysfunction due to moderate
mitral regurgitation and TCAV as well as renal impairment, he was treated with
diuretics and
digoxin. However, the
pleural effusion progressed gradually associated with exertional
dyspnea and moderate
edema of his lower legs. Chest computed tomography showed massive bilateral
pleural effusions without evidence of
malignancy in 2011. A pleural tap in 2011 revealed
chylothorax. Although
mammalian target of rapamycin inhibitors were major drugs for lymphoangioleimyomatosis, we believed that the
chylothorax was associated with EVL. EVL was discontinued in March 2011: the
chylothorax spontaneously resolved in November 2011.