Life-Threatening Everolimus-Associated Erosive-Hemorrhagic Gastropathy in a Liver Transplant Patient

We present the case of a patient who, following liver transplantation and optimization of the immunosuppressive regimen consisting of everolimus in combination with tacrolimus, presented several episodes of gastrointestinal bleeding, with endoscopic evidence of erosive hemorrhagic gastropathy. Modification of immunosuppression led to resolution of gastropathy and of bleeding events. Rare cases of life-threatening digestive hemorrhage due to everolimus have been reported in the literature, including a single case of hemorrhagic gastropathy. Given the widespread use of mammalian target of rapamycin inhibitors as part of chemotherapy or immunosuppressive protocols it is important to document this rare but potentially life-threatening side effect.