Acute exacerbation of interstitial pneumonia associated with rheumatoid arthritis during the course of treatment for Pneumocystis jirovecii pneumonia: A case report

被引：4

作者：

Kuroda T. ^{[1
]}

Takeuchi H. ^{[2
]}

Nozawa Y. ^{[1
]}

Sato H. ^{[1
]}

Nakatsue T. ^{[1
]}

Wada Y. ^{[1
]}

Moriyama H. ^{[2
]}

Nakano M. ^{[3
]}

Narita I. ^{[1
]}

机构：

[1] Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City

[2] Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City

[3] Department of Medical Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-Dori, Chuoku, Niigata City, 951-8518, Niigata

来源：

BMC Research Notes | / 9卷 / 1期

关键词：

Architectural distortions; Case report; Etanercept; Pneumocystis jirovecii pneumonia; Rheumatoid arthritis;

D O I：

10.1186/s13104-016-2052-0

中图分类号：

学科分类号：

摘要：

Background: Pneumocystis jirovecii pneumonia (PCP) is potentially fatal infectious complication in patients with rheumatoid arthritis (RA) during immunosuppressive therapy. Hospital survival due to human immunodeficiency virus - unrelated PCP reaches to 60 %. The high mortality rate results from difficulties in establishing an early diagnosis, concurrent use of prophylactic drugs, possible bacterial coinfection. We herein report a case of PCP in RA patients who developed the architectural distortions of lung in spite of combined modality therapy. Case presentation: A 73-year-old Japanese woman with RA was admitted with shortness of breath. Five weeks previously, she had been started on etanercept in addition to methotrexate (MTX). Chest computed tomography (CT) demonstrated diffuse ground glass opacities distributed throughout the bilateral middle to lower lung fields, and serum β-D-glucan was elevated. Bronchoalveolar lavage fluid revealed no P. jirovecii, but the organism was detected by polymerase chain reaction method. Trimethoprim/sulfamethoxazole was administered with methylprednisolone pulse therapy. However, the follow-up chest X-ray and chest CT demonstrated aggravation of the pneumonia with architectural distortions. Additional direct hemoperfusion with polymyxin B-immobilized fibers and intravenous cyclophosphamide therapy were insufficiently effective, and the patient died on day 25. Conclusion: The architectural distortions of lung should be considered as a cause of death of PCP. For this reason, a high suspicion of this infectious complication must be kept in mind in order to establish an early diagnosis and treatment in patients with RA managed with MTX and biologics. © 2016 Kuroda et al.

引用

共 19 条

[11]

Harigai M., Koike R., Miyasaka N., Pneumocystis pneumonia under anti-tumor necrosis factor therapy (PAT) study group. Pneumocystis pneumonia associated with infliximab in Japan, N Engl J Med, 357, pp. 1874-1876, (2007)

[12]

Tasaka S., Hasegawa N., Kobayashi S., Yamada W., Nishimura T., Takeuchi T., Ishizaka A., Serum indicators for the diagnosis of pneumocystis pneumonia, Chest, 131, pp. 1173-1180, (2007)

[13]

Mori S., Sugimoto M., Pneumocystis jirovecii Pneumonia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations, Clin Med Insights Circ Respir Pulm Med, 9, pp. 29-40, (2015)

[14]

Boiselle P.M., Crans C.A., Kaplan M.A., The changing face of Pneumocystis carinii pneumonia in AIDS patients, AJR, 172, pp. 1301-1309, (1999)

[15]

Kuhlman J.E., Pneumocystis infections: The radiologist's perspective, Radiology, 1198, pp. 623-635, (1996)

[16]

Tokuda H., Sakai F., Yamada H., Johkoh T., Imamura A., Dohi M., Hirakata M., Yamada T., Kamatani N., Kikuchi Y., Sugii S., Takeuchi T., Tateda K., Goto H., Clinical and radiological features of Pneumocystis pneumonia in patients with rheumatoid arthritis, in comparison with methotrexate pneumonitis and Pneumocystis pneumonia in acquired immunodeficiency syndrome: A multicenter study, Intern Med, 47, pp. 915-923, (2008)

[17]

Pareja J.G., Garland R., Koziel H., Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia, Chest, 113, pp. 1215-1224, (1998)

[18]

Enomoto N., Mikamo M., Oyama Y., Kono M., Hashimoto D., Fujisawa T., Inui N., Nakamura Y., Yasuda H., Kato A., Mimuro S., Doi M., Sato S., Suda T., Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival, BMC Pulm Med, 15, (2015)

[19]

Bodro M., Paterson D.L., Has the time come for routine trimethoprim-sulfamethoxazole prophylaxis in patients taking biologic therapies?, Clin Infect Dis, 56, pp. 1621-1628, (2013)

← 1 2 →