Sirolimus
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Oligospermia: case report A 26-year-old man experienced oligospermia during treatment with a sirolimus-based immunosuppressive regimen following a heart transplant [time to reaction onset not stated]. The man underwent heart transplantation and started receiving sirolimus [target trough concentration 6–8 ng/mL; dosage not stated], tacrolimus and corticosteroids; corticosteroids were discontinued after 6 month. Two years and 8 months later, he presented with a palpable space occupying lesion in the parenchyma of his left testicle and underwent left-sided inguinal orchidofuniculotomy. Perioperatively, sirolimus tapered and then replaced by mycophenolate mofetil (MMF) for 3 weeks. Histopathological examination of the testicle revealed a circumscribed tumour and he was diagnosed with benign Leydig-cell neoplasia with regressive alterations. Widespread testicular atrophy, vacuolisation of the seminiferous epithelium and decreased spermatogenesis were observed in the tumour-adjacent and distant areas. There was also slight interstitial oedema, fibrosis and hyperplasia of interstitial Leydig cells. He was unable to bring about spontaneous pregnancy in his partner and investigations revealed a marked reduction in sperm parameters with a sperm density of 2–3 × 106/mL and a total sperm motility of < 5%. His follicle-stimulating hormone (FSH) level was 27.5 mIU/mL and his luteinizing hormone (LH) level was 9.8 mIU/mL. Sirolimus was discontinued and replaced by MMF. During the following year, the man’s sperm quality and sex hormone levels were monitored three times and results showed continual improvement. One year after sirolimus withdrawal, he had a sperm density of 13 × 106/mL, a total sperm motility of 55%, a FSH level of 15.9 mIU/mL and a LH level of 7.0 mIU/mL. Subsequently, a spontaneous pregnancy of his partner was confirmed by positive urine and serum pregnancy tests and an ultrasound. Deutsch MA, et al. Sirolimus-associated infertility: case report and literature review of possible mechanisms. American Journal of Transplantation 7: 801091403 2414-2421, No. 10, Oct 2007 - Germany
0114-9954/10/1170-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 22 Sep 2007 No. 1170
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