Sirolimus
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Pericardial effusion leading to cardiac tamponade: case report A 28-year-old woman developed pericardial effusion and cardiac tamponade during treatment with sirolimus for graft-versus-host disease (GVHD) prophylaxis. The woman, who had been diagnosed with advanced myelodysplastic syndrome, had undergone cord blood transplantation and received sirolimus at a loading dose of 12mg followed by a daily oral dose to achieve blood trough levels of 8-12 ng/L, along with mycophenolate mofetil. On day 19, a small pericardial effusion was noted on chest CT scan and, over the next few days, she developed signs of rapidly progressive cardiac tamponade. A pericardiocentesis performed on day 28 yielded 350mL of clear, straw-coloured pericardial fluid. The fluid was confirmed as a transudate and cytology was negative for infection or malignancy. Cardiac tamponade recurred on day 35. On repeat pericardiocentesis, 600mL of transudate was obtained. The woman received methylprednisolone and sirolimus was stopped. Blood and pericardial fluid PCR was positive for human herpesvirus-6. Foscarnet was started 3 days after sirolimus discontinuation. She improved rapidly and her pericardial effusion did not recur. She was eventually discharged receiving mycophenolate mofetil and tapering doses of prednisone. Author comment: "We hypothesize that sirolimus was the most likely cause of pericardial effusion in this case, although the role of [human herpesvirus]-6 cannot be excluded completely." Holbro A, et al. Cardiac tamponade potentially related to sirolimus following cord blood transplantation. Bone Marrow Transplantation 47: 294-295, No. 2, Feb 2012. 803069815 Available from: URL: http://dx.doi.org/10.1038/bmt.2011.44 - Canada
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Reactions 5 May 2012 No. 1400
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