Thank you Dr. Olson for a fantastic morning report!
A middle-aged man s/p transplant on sirolimus and tacrolimus presents with progressive dyspnea and fevers.
Chest CT with progressive ground glass opacities in bilateral upper lobes that has progressed now to extensive cystic/cavitary disease over the last few months, despite antibiotics.
BAL with positive histo antigen in serum, urine, BAL, pleural fluid, and on Karius testing! Improves with holding immunosuppression and itraconazole treatment.
This case may have been infectious, but thank you for the great teaching point on when to consider sirolimus toxicity:
Thank you, Dr. Olson!
