Pneumocystis jiroveci pneumonia after total hip arthroplasty in a dermatomyositis patient:A case report

BACKGROUND Pneumocystis jiroveci pneumonia(PJP)is a serious opportunistic infection that occurs mostly in patients with immunodeficiency and long-term immunosuppressive therapy.In non-human immunodeficiency virus-infected patients,the most important risk factor for PJP is the use of glucocorticoids in combination with other immunosuppressive treatments.The management of glucocorticoids during the perioperative period in patients with dermatomyositis requires special care.CASE SUMMARY We report a case of PJP in the perioperative period.A 61-year-old woman with a history of anti-melanoma differentiation-associated gene 5(MDA5)-positive dermatomyositis and interstitial pneumonia was administered with long-term oral methylprednisolone and cyclosporine.The patient underwent right total hip arthroplasty in the orthopaedic department for bilateral osteonecrosis of the femoral head.She was given intravenous drip hydrocortisone before anesthesia and on the first day after surgery and resumed oral methylprednisolone on the second postoperative day.On the fifth day after surgery,the patient suddenly developed dyspnea.The computed tomography scan showed diffuse grid shadows and ground glass shadows in both lungs.Polymerase chain reaction testing of bronchoalveolar lavage fluid was positive for Pneumocystis jiroveci.The patient was eventually diagnosed with PJP and was administered with oral trimethoprim-sulfamethoxazole.At the 6-mo review,there was no recurrence or progression.CONCLUSION Continued perioperative glucocorticoid use in patients with anti-MDA5-positive dermatomyositis may increase the risk of PJP.

Pneumocystis jiroveci pneumonia and pneumomediastinum in an anti-TNFαnaive patient with ulcerative colitis

We report the case of a 21-year-old man who was noted to have pneumomediastinum during an admission for an acute flare of ulcerative colitis. At that time, he was on maintenance treatment with azathioprine at a dose of 2.25 mg/kg per day, and had not received supplementary steroids for 9 mo. He had never received anti-tumor necrosis factor （TNF）α therapy. Shortly after apparently effective treatment with intravenous steroids and an increased dose of azathioprine, he developed worsening colitic and new respiratory symptoms, and was diagnosed with Pneumocystis jiroveci （carinii） pneumonia （PCP）. Pneumomediastinum is rare in immunocompetent hosts, but is a recognized complication of PCP in human immunodeficiency virus （HIV） patients, although our patient＇s HIV test was negative. Treatment of PCP with co-trimoxazole resulted in resolution of both respiratory and gastrointestinal symptoms, without the need to increase the steroid dose. There is increasing vigilance for opportunistic infections in patients with inflammatory bowel disease following the advent of anti-TNFα therapy. This case emphasizes the importance of considering the possibility of such infections in all patients with inflammatory bowel disease, irrespective of the immunosuppressants they receive, and highlights the potential of steroid-responsive opportunistic infections to mimic worsening colitic symptoms in patients with ulcerative colitis.

Clinical parameters and outcomes of Pneumocystis jiroveci pneumonia in non-HIV/AIDS patients

Pneumocystis jiroveci pneumonia （PCP） is one of the most serious and potentially fatal infectionsencountered in immonosuppressed patients. It remains the most common cause of pulmonary morbidity and mortality in patients infected with human immunodeficiency virus （HIV）.

Spontaneous remission of Pneumocystisjiroveci pneumonia in 2 non-AIDS immunocompromised patients

Pneumocystis jiroveci （P. jiroveci） pneumonia （PCP） in non-AIDS immunocompromised patients ismuch more critical than that in AIDS patients,1 Without treatment, mortality of PCP in immunocompromised patients approaches 100 percent, and there were no reports of spontaneous remissions of PCP without anti-PCP therapy.2 Here we report 2 non-AIDS immunocompromised patients in whom PCP developed and remitted without treatment.

Caspofungin in salvage treatment of severe pneumocystis pneumonia： case report and literature review

Pneumocystis pneumonia （PCP） is one of the most critical and life-threatening infections in immunocompromised patients with AIDS （especially CD4^＋ T cell less than 0.2×10^9/L）, hematological malignancies, organ transplantation or connective tissue diseases. It is caused by a fungus called Pneumocystis jiroveci （P. jiroveci, formerly called P carinii）.

Diffuse lung involvement in rheumatoid arthritis:a respiratory physician’s perspective

The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis(RA),which is reported to occur in up to 60%to 80%of RA patients.Respiratory complications are the second leading cause of death due to RA.Although there is a wide spectrum of RA-associated respiratory diseases,interstitial lung disease is the most common manifestation and it impacts the prognosis of RA.There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease(RA-ILD)and RA-associated respiratory diseases recently,for example,opportunistic pulmonary infectious diseases and toxicity from RA therapies.From a chest physicians’perspective,we will update the diagnosis and treatment of RA-associated ILD,methotrexate-associated lung disease,and the complication of Pneumocystis jiroveci pneumonia in RA in this review.