Lymphoid Interstitial Pneumonia in a Renal Transplant Recipient

Objectives: A case report of lymphoid interstitial pneumonia (LIP) in a renal transplant patient who is immunosuppressed with tacrolimus.

Background: LIP is a rare lymphoproliferative disorder affecting the lungs. It is described in the literature as: diffuse infiltration of the alveolar septa by dense collections of lymphocytes and a mixture of plasma cells and other elements. LIP is associated with several conditions, most of which affect the immune system. The development of this condition following immunosuppression with sirolimus is mentioned in the literature but there are currently no documented cases on the development of LIP following treatment with tacrolimus.

Methods: Case report and literature review.

Results: A 44 year old lady with rapidly progressing renal failure secondary to IgA nephropathy developed progressive dyspnoea nine years after a cadaveric renal transplantation. She was immunosuppressed on tacrolimus. Plain chest film revealed bilateral interstitial infiltrates. Following open lung biopsy she was diagnosed with lymphoid interstitial pneumonia and made a good recovery after treatment with Prednisolone.

Conclusion: LIP is a rare complication of treatment with tacrolimus, to our knowledge this is the first reported case of this condition in a patient maintained on tacrolimus. A lung biopsy may be required as the differential diagnosis is vast and treatment with prednisolone can lead to good outcome.