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Choi, Kim, Kim, Yoon, Jun, and Sung: A Case of Pneumocystis Jirovecii Pneumonia in a Patient with Rheumatoid Arthritis
Case Report
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(6): 359-363.

Published online: 31 December 2012

DOI: https://doi.org/10.4078/jrd.2012.19.6.359

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

Eun-Young Choi1, Jin-Ok Kim1, Young-Sam Kim1, 2, Ho-Joo Yoon1, Jae-Bum Jun1, 2, Yoon-Kyoung Sung1, 2

1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

2Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.

Corresponding to: Yoon-Kyoung Sung, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 17, Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. sungyk@hanyang.ac.kr

Received 29 September 2011       Revised 13 February 2012       Accepted 27 February 2012

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pneumocystis jirovecii, Rheumatoid arthritis, Immunosuppressant

Figures and Tables

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.
jrd-19-359-g001
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.
jrd-19-359-g002
Figure 3
Chest X-ray 3 months after initial diagnosis of PJP shows nearly complete resolution of the bilateral lung infiltration.
jrd-19-359-g003

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