Pneumocystis jiroveci Pnemonia in Systemic Lupus Erythematosus: A Case report
Mohammad Ziaul Haider, Md Abdur Razzaque, Md Nahiduzzamane Shazzad, Syed Atiqul Haq, Shamim Ahmed, Syed Nesar Ahmed
Pneumocystis jiroveci pneumonia (PJP), formerly known as Pneumocystis carinii pneumonia (PCP) is the most common opportunistic infection in immunocompromised patients including patients with systemic lupus eythematosus (SLE). To our knowledge there was no case report on Pneumocystis jiroveci pneumonia among the patients with SLE in Bangladesh. We report on a case of SLE who developed PJP. A 37-year-old housewife with a 12-year history of SLE presented with dry cough, breathlessness and fever for one month. The patient had been treated with varying doses of corticosteroids and/or cytotoxic drugs within the last 12 years and had been taking cyclosporine 200 mg daily along with prednisolone 0.5 mg/ kg body weight with gradual tapered dose to 7.5 mg/day for 3 months before presentation. Her Chest X-ray revealed bilateral diffuse infiltrate, CT scan of chest also disclosed bilateral diffuse infiltrate. Diagnosis was established based on the findings of Geimsa stain of induced sputum. After treatment with Trimethoprim-sulfamethoxazole (TMP-SMX; TMP: 5mg/kg, SMX: 25mg/kg 8 hourly) the patient improved clinically and discharged to home. Patients with SLE like other immunocompromised patients presenting with fever, cough and breathlessness should arouse a high suspicion for Pneumocystis Jiroveci pneumonia. Patients with SLE treated with corticosteroids and cytotoxic drugs may be at increased risk for this opportunistic infection.