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Pneumocystis jirovecii pneumonia in inflammatory rheumatic systemic diseases under immunosuppressive therapy: Two case reports, current overviews

Gabriel Dischereit, Uwe Lange, Astrid Thiele & Tim Schmeiser

Infection with pneumocystis jirovecii is one of the most common AIDS (Acquired Immune Deficiency Syndromes) defining diseases. There is an increased risk of clinical apparent pneumocystis jirovecii infections due to cellular immunodeficiency. Other patients with a higher risk for an infection with pneumocystis jirovecii are those with malignant diseases, condition after stem cell transplantation or after transplantation of solid organs, and patients receiving immunosuppressive therapy due to autoimmune disorders. Therefore, patients with inflammatory rheumatic diseases are often at an increased risk for opportunistic infections such as pneumocystis jirovecii pneumonia (PcP). The PcP is transmitted aerogenically or it can be a result of reactivation of a latent infection after immunosuppression. Leading symptoms are dyspnea on effort, coughing and sub febrile temperature. For detection of the pathogen staining methods or molecular genetic methods are used. Furthermore, imaging, in particular highresolution computed tomography, plays an essential role. The most important medication for treatment is Trimethoprim and Sulfamethoxazole. Sometimes an adjuvant corticosteroid treatment is recommended, whereas evidence for benefits in patients with inflammatory rheumatic disease is lacking. A primary chemoprophylaxis is recommended for patients on high intensive or combined immunosuppression or under high-dose systemic corticosteroid treatment. Also in this case Trimethoprim/Sulfamethoxazole are treatment of choice. Here we describe two case reports on clinical pneumocystis jirovecii infection under immunosuppressive medication in patients with rheumatic diseases and we give an overview on current literature with regard to rheumatic therapy options.