Achromobacter denitrificans pneumonia
in a kidney transplant recipient –
dose-dependent decrease of phagocytic
activity as a potential mechanism
for everolimus pulmonary toxicity

Justyna Eliza Gołębiewska; Ewa Bryl; Agnieszka Daca; Andrzej Chamienia; Dominik Świętoń; Alicja Dębska-Ślizień

doi:10.5114/ceji.2021.108762

eISSN: 1644-4124
ISSN: 1426-3912

Central European Journal of Immunology

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abstract:

Case report

Achromobacter denitrificans pneumonia in a kidney transplant recipient – dose-dependent decrease of phagocytic activity as a potential mechanism for everolimus pulmonary toxicity

Justyna Eliza Gołębiewska

¹

,

Ewa Bryl

²

,

Agnieszka Daca

²

,

Andrzej Chamienia

¹

,

Dominik Świętoń

³

,

Alicja Dębska-Ślizień

¹

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
Department of Pathology and Experimental Rheumatology, Medical University of Gdańsk, Poland
Department of Radiology, Medical University of Gdańsk, Poland

Cent Eur J Immunol 2021; 46 (3): 405-417

DOI: https://doi.org/10.5114/ceji.2021.108762

Online publish date: 2021/09/28

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AMA

Eliza Gołębiewska J, Bryl E, Daca A, Chamienia A, Świętoń D, Dębska-Ślizień A. Achromobacter denitrificans pneumonia
in a kidney transplant recipient –
dose-dependent decrease of phagocytic
activity as a potential mechanism
for everolimus pulmonary toxicity. Central European Journal of Immunology. 2021;46(3):405-417. doi:10.5114/ceji.2021.108762.

APA

Eliza Gołębiewska, J., Bryl, E., Daca, A., Chamienia, A., Świętoń, D.,  & Dębska-Ślizień, A. (2021). Achromobacter denitrificans pneumonia
in a kidney transplant recipient –
dose-dependent decrease of phagocytic
activity as a potential mechanism
for everolimus pulmonary toxicity. Central European Journal of Immunology, 46(3), 405-417. https://doi.org/10.5114/ceji.2021.108762

Chicago

Eliza Gołębiewska, Justyna, Ewa Bryl, Agnieszka Daca, Andrzej Chamienia, Dominik Świętoń,  and Alicja Dębska-Ślizień. 2021. "Achromobacter denitrificans pneumonia
in a kidney transplant recipient –
dose-dependent decrease of phagocytic
activity as a potential mechanism
for everolimus pulmonary toxicity". Central European Journal of Immunology 46 (3): 405-417. doi:10.5114/ceji.2021.108762.

Harvard

Eliza Gołębiewska, J., Bryl, E., Daca, A., Chamienia, A., Świętoń, D.,  and Dębska-Ślizień, A. (2021). Achromobacter denitrificans pneumonia
in a kidney transplant recipient –
dose-dependent decrease of phagocytic
activity as a potential mechanism
for everolimus pulmonary toxicity. Central European Journal of Immunology, 46(3), pp.405-417. https://doi.org/10.5114/ceji.2021.108762

MLA

Eliza Gołębiewska, Justyna et al. "Achromobacter denitrificans pneumonia
in a kidney transplant recipient –
dose-dependent decrease of phagocytic
activity as a potential mechanism
for everolimus pulmonary toxicity." Central European Journal of Immunology, vol. 46, no. 3, 2021, pp. 405-417. doi:10.5114/ceji.2021.108762.

Vancouver

Eliza Gołębiewska J, Bryl E, Daca A, Chamienia A, Świętoń D, Dębska-Ślizień A. Achromobacter denitrificans pneumonia
in a kidney transplant recipient –
dose-dependent decrease of phagocytic
activity as a potential mechanism
for everolimus pulmonary toxicity. Central European Journal of Immunology. 2021;46(3):405-417. doi:10.5114/ceji.2021.108762.

PlumX metrics:

Mammalian target of rapamycin (mTOR) inhibitors inclusive regimens are associated with increased risk of pulmonary toxicity, but the underlying mechanism has not been elucidated so far.

We present the case of a 68-year-old man, after deceased-donor kidney transplantation (KTx), maintained on de novo everolimus (EVR) based immunosuppression, who developed Achromobacter denitrificans pneumonia 3 months after KTx. There was clinical improvement with antibiotic treatment, but without a radiological resolution. An additional reduction of the EVR dose resulted only in partial resolution of radiological abnormalities. We performed a functional analysis of peripheral blood neutrophils and monocytes. The ability of phagocytosis and oxidative burst generation against A. denitrificans and Escherichia coli was significantly decreased on EVR treatment as compared to the control healthy person, and significantly improved after 3 weeks of EVR absence. Additionally, these processes were significantly affected by increasing doses of EVR in vitro in the control healthy donor in a dose-dependent manner. EVR discontinuation, with no additional antibiotic treatment, resulted in complete recovery and resolution of pulmonary infiltrates.

Our findings suggest that dose-dependent impairment of neutrophil/monocyte phagocytic activity and oxidative burst generation might be a potential mechanism for EVR pulmonary toxicity.

keywords:

Achromobacter denitrificans pneumonia in a kidney transplant recipient – dose-dependent decrease of phagocytic activity as a potential mechanism for everolimus pulmonary toxicity

Justyna Eliza Gołębiewska 1 , Ewa Bryl 2 , Agnieszka Daca 2 , Andrzej Chamienia 1 , Dominik Świętoń 3 , Alicja Dębska-Ślizień 1

kidney transplantation, Achromobacter denitrificans, mTOR inhibitors, everolimus, phagocytosis, oxidative burst generation

Justyna Eliza Gołębiewska

¹

,

Ewa Bryl

²

,

Agnieszka Daca

²

,

Andrzej Chamienia

¹

,

Dominik Świętoń

³

,

Alicja Dębska-Ślizień

¹