{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T04:57:21Z","timestamp":1770785841327,"version":"3.50.0"},"reference-count":36,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:p>Immunosuppressive drugs are an integral part of therapy in organ transplantation. However, they are not without side effects, and although rare, these agents should be considered in the differential diagnosis of pulmonary complications in patients receiving transplants. We present a case of a patient who developed acute respiratory failure 7 days after orthotopic heart transplantation and who had been on both mycophenolate mofetil (MMF) and tacrolimus agents. Lung biopsy revealed features of pulmonary hemorrhage with capillaritis. Considered as a possible etiology, MMF was withdrawn. There was immediate improvement of the patient's symptoms. The temporal relationship between MMF exposure and onset of pulmonary symptoms in the absence of other possible etiologies strongly suggests a causal relationship. Previously published reports of pulmonary toxicity from MMF included interstitial fibrosis. To the best of our knowledge, this is the first reported case of pulmonary hemorrhage with capillaritis because of administration of MMF.<\/jats:p>","DOI":"10.5858\/arpa.2012-0460-cr","type":"journal-article","created":{"date-parts":[[2013,10,30]],"date-time":"2013-10-30T08:55:31Z","timestamp":1383123331000},"page":"1684-1687","source":"Crossref","is-referenced-by-count":9,"title":["Pulmonary Hemorrhage With Capillaritis Secondary to Mycophenolate Mofetil in a Heart-Transplant Patient"],"prefix":"10.5858","volume":"137","author":[{"given":"Maria","family":"Gorgan","sequence":"first","affiliation":[{"name":"From the Departments of Pathology (Drs Gorgan and Fiel-Gan), Radiology (Dr Volpe), Infectious Diseases (Dr Lawlor), and Internal Medicine (Dr Bockorny), Hartford Hospital, Hartford, Connecticut."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Bockorny","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology (Drs Gorgan and Fiel-Gan), Radiology (Dr Volpe), Infectious Diseases (Dr Lawlor), and Internal Medicine (Dr Bockorny), Hartford Hospital, Hartford, Connecticut."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Lawlor","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology (Drs Gorgan and Fiel-Gan), Radiology (Dr Volpe), Infectious Diseases (Dr Lawlor), and Internal Medicine (Dr Bockorny), Hartford Hospital, Hartford, Connecticut."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Volpe","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology (Drs Gorgan and Fiel-Gan), Radiology (Dr Volpe), Infectious Diseases (Dr Lawlor), and Internal Medicine (Dr Bockorny), Hartford Hospital, Hartford, Connecticut."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Fiel-Gan","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology (Drs Gorgan and Fiel-Gan), Radiology (Dr Volpe), Infectious Diseases (Dr Lawlor), and Internal Medicine (Dr Bockorny), Hartford Hospital, Hartford, Connecticut."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3906","reference":[{"issue":"2","key":"i1543-2165-137-11-1684-b01","series-title":"Chest","first-page":"508","article-title":"Pulmonary complications in cardiac transplant recipients","volume":"120","author":"Lenner\n              R,","year":"2001","unstructured":"Lenner\n              R, \n            \n              Padilla\n              M, \n            \n              Teirstein\n              AS, \n            \n              Gass\n              A, \n            \n              Schilero\n              GI. \n          \n          Pulmonary complications in cardiac transplant recipients. Chest. 2001;120(2):508\u2013513."},{"issue":"5","key":"i1543-2165-137-11-1684-b02","series-title":"Transplant Proc","first-page":"1530","article-title":"Pulmonary complications in heart transplant recipients","volume":"38","author":"Atasever\n              A,","year":"2006","unstructured":"Atasever\n              A, \n            \n              Bacakoglu\n              F, \n            \n              Uysal\n              FE, \n            et al\n          . Pulmonary complications in heart transplant recipients. Transplant Proc. 2006;38(5):1530\u20131534."},{"issue":"2","key":"i1543-2165-137-11-1684-b03","series-title":"Radiographics","first-page":"321","article-title":"Imaging of cardiac transplantation complications","volume":"19","author":"Knisley\n              BL,","year":"1999","unstructured":"Knisley\n              BL, \n            \n              Mastey\n              LA, \n            \n              Collins\n              J, \n            \n              Kuhlman\n              JE. \n          \n          Imaging of cardiac transplantation complications. Radiographics. 1999;19(2):321\u2013341."},{"issue":"10","key":"i1543-2165-137-11-1684-b04","series-title":"J Am Soc Echocardiogr","first-page":"1039","article-title":"Acute thrombus formation as a complication of right ventricular biopsy","volume":"23","author":"Verres\n              G,","year":"2010","unstructured":"Verres\n              G, \n            \n              Bruce\n              CJ, \n            \n              Kutzke\n              K, \n            et al\n          . Acute thrombus formation as a complication of right ventricular biopsy. 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Chest. 1996;110(5):1305\u20131316."},{"issue":"1","key":"i1543-2165-137-11-1684-b06","series-title":"Curr Rheumatol Rep","first-page":"55","article-title":"Drug-induced vasculitis","volume":"4","author":"Cuellar\n              MA.","year":"2002","unstructured":"Cuellar\n              MA. \n          \n          Drug-induced vasculitis. Curr Rheumatol Rep. 2002;4(1):55\u201359."},{"issue":"5","key":"i1543-2165-137-11-1684-b07","series-title":"Chest","first-page":"1485","article-title":"Diffuse alveolar hemorrhage and pulmonary capillaritis due to propylthiouracil","volume":"116","author":"Dhillon\n              SS,","year":"1999","unstructured":"Dhillon\n              SS, \n            \n              Singh\n              D, \n            \n              Doe\n              N, \n            \n              Qadri\n              AM, \n            \n              Ricciardi\n              S, \n            \n              Schwartz\n              MI. \n          \n          Diffuse alveolar hemorrhage and pulmonary capillaritis due to propylthiouracil. Chest. 1999;116(5):1485\u20131488."},{"issue":"4","key":"i1543-2165-137-11-1684-b08","series-title":"Am J Respir Crit Care Med","first-page":"1302","article-title":"Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome","volume":"158","author":"Nicolls\n              MR,","year":"1998","unstructured":"Nicolls\n              MR, \n            \n              Terada\n              LS, \n            \n              Tuder\n              RM, \n            \n              Prindivillle\n              SA, \n            \n              Schwartz\n              MI. \n          \n          Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome. Am J Respir Crit Care Med. 1998;158(4):1302\u20131305."},{"issue":"11","key":"i1543-2165-137-11-1684-b09","series-title":"Transplantation","first-page":"1607","article-title":"Acute respiratory failure and pulmonary fibrosis secondary to administration of mycophenolate mofetil","volume":"64","author":"Gross\n              DC,","year":"1997","unstructured":"Gross\n              DC, \n            \n              Sasaki\n              TM, \n            \n              Buick\n              MK, \n            \n              Light\n              JA. \n          \n          Acute respiratory failure and pulmonary fibrosis secondary to administration of mycophenolate mofetil. Transplantation. 1997;64(11):1607\u20131609."},{"issue":"10","key":"i1543-2165-137-11-1684-b10","series-title":"Transplantation","first-page":"1414","article-title":"Pulmonary fibrosis secondary to administration of mycophenolate mofetil","volume":"65","author":"Morrissey\n              P,","year":"1998","unstructured":"Morrissey\n              P, \n            \n              Gohh\n              R, \n            \n              Madras\n              P, \n            \n              Monaco\n              AP. \n          \n          Pulmonary fibrosis secondary to administration of mycophenolate mofetil. Transplantation. 1998;65(10):1414."},{"issue":"1","key":"i1543-2165-137-11-1684-b11","series-title":"Br J Clin Pharmacol","first-page":"61S","article-title":"Immunosuppressant drugs\u2014role of therapeutic drug monitoring","volume":"52","author":"Johnston\n              A,","year":"2001","unstructured":"Johnston\n              A, \n            \n              Holt\n              DW. \n          \n          Immunosuppressant drugs\u2014role of therapeutic drug monitoring. Br J Clin Pharmacol. 2001;52(1)(suppl):61S\u201373S."},{"issue":"2","key":"i1543-2165-137-11-1684-b12","series-title":"Drugs","first-page":"278","article-title":"Mycophenolate mofetil: a review of its pharmacodynamic and pharmacokinetic properties and clinical efficacy in renal transplantation","volume":"51","author":"Fulton\n              B,","year":"1996","unstructured":"Fulton\n              B, \n            \n              Markham\n              A. \n          \n          Mycophenolate mofetil: a review of its pharmacodynamic and pharmacokinetic properties and clinical efficacy in renal transplantation. 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Biochem Pharmacol. 1990;39(9):1467\u20131471."},{"issue":"2","key":"i1543-2165-137-11-1684-b16","series-title":"Arthritis Rheum","first-page":"278","article-title":"Mycophenolate mofetil for remission maintenance in the treatment of Wegener's granulomatosis","volume":"51","author":"Langford\n              CA,","year":"2004","unstructured":"Langford\n              CA, \n            \n              Tallar-Williams\n              C, \n            \n              Sneller\n              MC. \n          \n          Mycophenolate mofetil for remission maintenance in the treatment of Wegener's granulomatosis. 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Chest. 2001;120(2):508\u2013513."},{"issue":"5","key":"i1543-2165-137-11-1684-b02","series-title":"Transplant Proc","first-page":"1530","article-title":"Pulmonary complications in heart transplant recipients","volume":"38","author":"Atasever\n              A,","year":"2006","unstructured":"Atasever\n              A, \n            \n              Bacakoglu\n              F, \n            \n              Uysal\n              FE, \n            et al\n          . Pulmonary complications in heart transplant recipients. 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Chest. 1999;116(5):1485\u20131488."},{"issue":"4","key":"i1543-2165-137-11-1684-b08","series-title":"Am J Respir Crit Care Med","first-page":"1302","article-title":"Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome","volume":"158","author":"Nicolls\n              MR,","year":"1998","unstructured":"Nicolls\n              MR, \n            \n              Terada\n              LS, \n            \n              Tuder\n              RM, \n            \n              Prindivillle\n              SA, \n            \n              Schwartz\n              MI. \n          \n          Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome. 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Science. 1995;268(5210):585\u2013586."},{"issue":"9","key":"i1543-2165-137-11-1684-b15","series-title":"Biochem Pharmacol","first-page":"1467","article-title":"Mechanism of inactivation of myeloperoxidase by propylthiouracil","volume":"39","author":"Lee\n              E,","year":"1990","unstructured":"Lee\n              E, \n            \n              Kariya\n              K, \n            \n              Miki\n              Y, \n            \n              Katsljra\n              H. \n          \n          Mechanism of inactivation of myeloperoxidase by propylthiouracil. Biochem Pharmacol. 1990;39(9):1467\u20131471."},{"issue":"2","key":"i1543-2165-137-11-1684-b16","series-title":"Arthritis Rheum","first-page":"278","article-title":"Mycophenolate mofetil for remission maintenance in the treatment of Wegener's granulomatosis","volume":"51","author":"Langford\n              CA,","year":"2004","unstructured":"Langford\n              CA, \n            \n              Tallar-Williams\n              C, \n            \n              Sneller\n              MC. \n          \n          Mycophenolate mofetil for remission maintenance in the treatment of Wegener's granulomatosis. 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J Am Soc Nephrol. 1999;10(9):1965\u20131971."},{"issue":"1","key":"i1543-2165-137-11-1684-b18","series-title":"Scand J Respir Dis","first-page":"41","article-title":"Nitrofurantoin-induced acute, subacute and chronic pulmonary reactions","volume":"58","author":"Sovij\u00e4rvi\n              AR,","year":"1977","unstructured":"Sovij\u00e4rvi\n              AR, \n            \n              Lemola\n              M, \n            \n              Stenius\n              B, \n            \n              Id\u00e4np\u00e4\u00e4n-Heikkil\u00e4\n              J. \n          \n          Nitrofurantoin-induced acute, subacute and chronic pulmonary reactions. 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