Do m-TOR Inhibitors Cause Bullous Pemphigoid?

The use of everolimus or sirolimus to prevent organ rejection in transplant recipients has become increasingly common. Both agents inhibit the mammalian target of rapamycin (m-TOR), a component of an intracellular pathway that mediates proliferation. Clinicians in Italy describe two cases in which administration of everolimus or sirolimus was associated with development of the autoimmune disease bullous pemphigoid.

The first patient was a 35-year-old woman with a renal transplant in whom a blistering disease developed upon dosage escalation of everolimus. Dose reduction improved the skin disease but generated evidence of rejection. When the dosage was raised again, the pemphigoid relapsed. The second patient was a 65-year-old man with a rena…