J Rheum Dis.  2012 Dec;19(6):359-363. 10.4078/jrd.2012.19.6.359.

A Case of Pneumocystis Jirovecii Pneumonia in a Patient with Rheumatoid Arthritis

Affiliations
  • 1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. sungyk@hanyang.ac.kr
  • 2Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.

Abstract

We report a 67-year-old woman who developed Pneumocystis jirovecii pneumonia (PJP) as a complication of treatment with immunosuppressant, such as methotrexate and leflunomide, for rheumatoid arthritis. She had mild fever and non-productive cough, but there was neither symptoms of dyspnea nor typical X-ray findings at initial presentation. However, rapid progression on a chest X-ray, respiratory symptoms and findings of high-resolution chest computed tomography in a few days suggested a possibility of PJP infection. A polymerase chain reaction-based detection of Pneumocystis jirovecii in induced sputum allowed us an early diagnosis of PJP. Through a preemptive treatment with Trimethoprim-sulfamethoxazole, she fully recovered from PJP.

Keyword

Pneumocystis jirovecii; Rheumatoid arthritis; Immunosuppressant

MeSH Terms

Arthritis, Rheumatoid
Cough
Dyspnea
Early Diagnosis
Female
Fever
Humans
Isoxazoles
Methotrexate
Pneumocystis
Pneumocystis jirovecii
Pneumonia
Sputum
Thorax
Trimethoprim, Sulfamethoxazole Drug Combination
Isoxazoles
Methotrexate

Figure

  • Figure 1 Chest X-ray (A) and CT (B) on admission showed diffuse ground-glass opacities, as well as reticular infiltrates in both lung fields.

  • Figure 2 Chest X-ray (A) and CT (B) on the forth hospital day showed diffuse bilateral infiltration that progressed over the next 3 days.

  • Figure 3 Chest X-ray 3 months after initial diagnosis of PJP shows nearly complete resolution of the bilateral lung infiltration.


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