PMC8574107_01
A) Initial computed tomography (CT) of the lungs shows poorly defined bilateral patchy consolidations without pleural effusion, B) chest CT after 3-week antibiotic treatment and everolimus (EVR) dose reduction shows only partial resolution of bilateral patchy consolidations, C) CT performed 10 weeks after EVR discontinuation shows complete resolution of symptoms
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F1
An HRCT scan (Fig. 1A) revealed a disseminated nodular pattern in both lungs, accompanied by peribronchial consolidations and lung parenchyma retraction dominating in the lower lobes. EVR pulmonary toxicity was made. A 17-day course of piperacillin/tazobactam chosen according to the susceptibility profile (Table 2), and a reduction of the EVR dose to the target trough levels of 2.8-3.2 ng/ml resulted only in partial resolution of radiological abnormalities confirmed by HRCT (Fig. 1B). After three weeks of antibiotic treatment EVR was withheld. EVR discontinuation with no additional antibiotic treatment resulted in complete recovery and a complete resolution of pulmonary infiltrates in an HRCT performed at a further 10-week follow-up (Fig. 1C).
Ex vivo phagocytic activity of neutrophils and monocytes against Escherichia coli and achromobacter denitrificans measured by mean fluorescent intensity (MFI)
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F2
The phagocytic activity of patient cells off EVR against A. denitrificans was similar to the activity of healthy controls; however, the activity of patient cells off EVR against E. coli was still below the activity of control cells (Fig. 2).
Ex vivo intensity of oxidative burst of neutrophils and monocytes against Escherichia coli and achromobacter denitrificans measured by mean fluorescent intensity (MFI)
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F3
The level of oxidative burst carried out by patient monocytes was also improved with EVR absence, but still lower by half compared to monocytes of a healthy control (Fig. 3).
in vitro phagocytic activity against Escherichia coli and achromobacter denitrificans of a healthy volunteer's neutrophils and monocytes exposed to different everolimus (EVR) concentrations measured by mean fluorescent intensity (MFI)
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F4
The processes of phagocytosis and oxidative burst generation against both A. denitrificans and E. coli were again significantly affected by increasing doses of EVR in a dose-dependent manner (Figs. 4 and 5).
in vitro intensity of oxidative burst against Escherichia coli and achromobacter denitrificans of a healthy volunteer's neutrophils and monocytes exposed to different everolimus (EVR) concentrations measured by the mean fluorescent intensity (MFI)
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F5
The processes of phagocytosis and oxidative burst generation against both A. denitrificans and E. coli were again significantly affected by increasing doses of EVR in a dose-dependent manner (Figs. 4 and 5).