Journal of the American Academy of Dermatology
Volume 63, Issue 5 , Pages 815-823 , November 2010

Role of primary prophylaxis for pneumocystis pneumonia in patients treated with systemic corticosteroids or other immunosuppressive agents for immune-mediated dermatologic conditions

  • Julia S. Lehman, MD
    • ,
  • Amer N. Kalaaji, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Amer N. Kalaaji, MD, Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

,Accepted 22 November 2009.

References 

  1. Sen RP, Walsh TE, Fisher W, Brock N. Pulmonary complications of combination therapy with cyclophosphamide and prednisone. Chest. 1991;99:143–146
  2. Godeau B, Coutant-Perronne V, Le Thi Huong D, Guillevin L, Magadur G, De Bandt M, et al. Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases. J Rheumatol. 1994;21:246–251
  3. Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc. 1996;71:5–13
  4. Komano Y, Harigai M, Koike R, Sugiyama H, Ogawa J, Saito K, et al. Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: a retrospective review and case-control study of 21 patients. Arthritis Rheum. 2009;61:305–312
  5. Duncan KO, Imaeda S, Milstone LM. Pneumocystis carinii pneumonia complicating methotrexate treatment of pityriasis rubra pilaris. J Am Acad Dermatol. 1998;39:276–278
  6. Takenaka R, Okada H, Mizuno M, Nasu J, Toshimori J, Tatsukawa M, et al. Pneumocystis carinii pneumonia in patients with ulcerative colitis. J Gastroenterol. 2004;39:1114–1115
  7. De Silva BD, Buxton PK. Pneumocystis carinii pneumonia in a patient with pyoderma gangrenosum treated with cyclosporin. Br J Dermatol. 2000;143:683–684
  8. Meuli K, Chapman P, O'Donnell J, Frampton C, Stamp L. Audit of pneumocystis pneumonia in patients seen by the Christchurch Hospital rheumatology service over a 5-year period. Intern Med J. 2007;37:687–692
  9. Kalyoncu U, Karadag O, Akdogan A, Kisacik B, Erman M, Erguven S, et al. Pneumocystis carinii pneumonia in a rheumatoid arthritis patient treated with adalimumab. Scand J Infect Dis. 2007;39:475–478
  10. Totet A, Westeel PF, Nevez G. Severe pneumocystis pneumonia in a renal transplant recipient after long term mycophenolate mofetil treatment. Rev Inst Med Trop Sao Paulo. 2005;47:303–304
  11. Azevedo LS, Castro MC, Paula FJ, Ianhez LE, David-Neto E. Mycophenolate mofetil may protect against Pneumocystis carinii pneumonia in renal transplanted patients. Rev Inst Med Trop Sao Paulo. 2005;47:143–145
  12. Podrebarac TA, Jovaisas A, Karsh J. Pneumocystis carinii pneumonia after discontinuation of hydroxychloroquine in 2 patients with systemic lupus erythematosus. J Rheumatol. 1996;23:199–200
  13. Green H, Paul M, Vidal L, Leibovici L. Prophylaxis of pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc. 2007;82:1052–1059
  14. Raychaudhuri SP, Siu S. Pneumocystis carinii pneumonia in patients receiving immunosuppressive drugs for dermatological diseases. Br J Dermatol. 1999;141:528–530
  15. Lemaire CM, Browning JC, Hsu S. Medical pearl: pneumocystis pneumonia prophylaxis for patients on chronic systemic corticosteroids. J Am Acad Dermatol. 2006;55:124–125
  16. Gerhart JL, Kalaaji AN. Development of Pneumocystis carinii pneumonia in patients with immunobullous and connective tissue disease receiving immunosuppressive medications. J Am Acad Dermatol. 2010;62:957–961
  17. Bachelez H, Schremmer B, Cadranel J, Mouly F, Sarfati C, Agbalika F, et al. Fulminant Pneumocystis carinii pneumonia in 4 patients with dermatomyositis. Arch Intern Med. 1997;157:1501–1503
  18. McGarry H, McLelland J. Pneumocystis carinii pneumonia in a patient on immunosuppressive drugs for pyoderma gangrenosum. Br J Dermatol. 2002;147:192–193
  19. Maronn ML, Corden T, Drolet BA. Pneumocystis carinii pneumonia in infant treated with oral steroids for hemangioma. Arch Dermatol. 2007;143:1224–1225
  20. Aviles R, Boyce TG, Thompson DM. Pneumocystis carinii pneumonia in a 3-month-old infant receiving high-dose corticosteroid therapy for airway hemangiomas. Mayo Clin Proc. 2004;79:243–245
  21. Ognibene FP, Shelhamer JH, Hoffman GS, Kerr GS, Reda D, Fauci AS, et al. Pneumocystis carinii pneumonia: a major complication of immunosuppressive therapy in patients with Wegener's granulomatosis. Am J Respir Crit Care Med. 1995;151:795–799
  22. Gupta D, Zachariah A, Roppelt H, Patel AM, Gruber BL. Prophylactic antibiotic usage for Pneumocystis jiroveci pneumonia in patients with systemic lupus erythematosus on cyclophosphamide: a survey of US rheumatologists and the review of literature. J Clin Rheumatol. 2008;14:267–272
  23. Iikuni N, Kitahama M, Ohta S, Okamoto H, Kamatani N, Nishinarita M. Evaluation of pneumocystis pneumonia infection risk factors in patients with connective tissue disease. Mod Rheumatol. 2006;16:282–288
  24. Lertnawapan R, Totemchokchyakarn K, Nantiruj K, Janwityanujit S. Risk factors of Pneumocystis jiroveci pneumonia in patients with systemic lupus erythematosus. Rheumatol Int. 2009;29:491–496
  25. Kadoya A, Okada J, Iikuni Y, Kondo H. Risk factors for Pneumocystis carinii pneumonia in patients with polymyositis/dermatomyositis or systemic lupus erythematosus. J Rheumatol. 1996;23:1186–1188
  26. Mansharamani NG, Balachandran D, Vernovsky I, Garland R, Koziel H. Peripheral blood CD4+ T-lymphocyte counts during Pneumocystis carinii pneumonia in immunocompromised patients without HIV infection. Chest. 2000;118:712–720
  27. Badsha H, Kong KO, Lian TY, Chan SP, Edwards CJ, Chng HH. Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications. Lupus. 2002;11:508–513
  28. US Public Health Service Task Force on Antipneumocystis Prophylaxis in Patients with Human Immunodeficiency Virus Infection. Recommendations for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. J Acquir Immune Defic Syndr. 1993;6:46–55
  29. Gallant JE, Moore RD, Chaisson RE. Prophylaxis for opportunistic infections in patients with HIV infection. Ann Intern Med. 1994;120:932–944
  30. Bozzette SA, Finkelstein DM, Spector SA, Frame P, Powderly WG, He W, et al. NIAID AIDS Clinical Trials Group A randomized trial of three antipneumocystis agents in patients with advanced human immunodeficiency virus infection. N Engl J Med. 1995;332:693–699
  31. Kimura M, Tanaka S, Ishikawa A, Endo H, Hirohata S, Kondo H. Comparison of trimethoprim-sulfamethoxazole and aerosolized pentamidine for primary prophylaxis of Pneumocystis jiroveci pneumonia in immunocompromised patients with connective tissue disease. Rheumatol Int. 2008;28:673–676
  32. Kovacs JA, Gill VJ, Meshnick S, Masur H. New insights into transmission, diagnosis, and drug treatment of Pneumocystis carinii pneumonia. JAMA. 2001;286:2450–2460
  33. Jick H, Derby LE. A large population-based follow-up study of trimethoprim-sulfamethoxazole, trimethoprim, and cephalexin for uncommon serious drug toxicity. Pharmacotherapy. 1995;15:428–432
  34. Rodriguez M, Fishman JA. Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients. Clin Microbiol Rev. 2004;17:770–782
  35. Mori S, Cho I, Ichiyasu H, Sugimoto M. Asymptomatic carriage of Pneumocystis jiroveci in elderly patients with rheumatoid arthritis in Japan: a possible association between colonization and development of Pneumocystis jiroveci pneumonia during low-dose MTX therapy. Mod Rheumatol. 2008;18:240–246
  36. Festic E, Gajic O, Limper AH, Aksamit TR. Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection: outcome and associated features. Chest. 2005;128:573–579
  37. Ward MM, Donald F. Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality. Arthritis Rheum. 1999;42:780–789
  38. Li J, Huang XM, Fang WG, Zeng XJ. Pneumocystis carinii pneumonia in patients with connective tissue disease. J Clin Rheumatol. 2006;12:114–117
  39. Mansharamani NG, Garland R, Delaney D, Koziel H. Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states. Chest. 2000;118:704–711
  40. Sepkowitz KA, Brown AE, Telzak EE, Gottlieb S, Armstrong D. Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital. JAMA. 1992;267:832–837
  41. Falagas ME, Manta KG, Betsi GI, Pappas G. Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin Rheumatol. 2007;26:663–670
  42. Thomas CF, Limper AH. Pneumocystis pneumonia: clinical presentation and diagnosis in patients with and without acquired immune deficiency syndrome. Semin Respir Infect. 1998;13:289–295
  43. Ogawa J, Harigai M, Nagasaka K, Nakamura T, Miyasaka N. Prediction of and prophylaxis against pneumocystis pneumonia in patients with connective tissue diseases undergoing medium- or high-dose corticosteroid therapy. Mod Rheumatol. 2005;15:91–96
  44. Flori P, Bellete B, Durand F, Raberin H, Cazorla C, Hafid J, et al. Comparison between real-time PCR, conventional PCR and different staining techniques for diagnosing Pneumocystis jiroveci pneumonia from bronchoalveolar lavage specimens. J Med Microbiol. 2004;53:603–607
  45. Rencic A, Caeiro JP, Hernandez MI, Nousari HC. Prophylaxis in dermatologic patients receiving immunosuppressive therapy. Dermatol Ther. 2002;15:352–361

 Funding sources: None.

 Conflicts of interest: None declared.

PII: S0190-9622(09)02112-4

doi: 10.1016/j.jaad.2009.11.588

Journal of the American Academy of Dermatology
Volume 63, Issue 5 , Pages 815-823 , November 2010

Article Tools