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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
06:35

An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis

Published on: February 8, 2019

Pneumocystis jiroveci pneumonia in giant cell arteritis: A case series

Tanaz A Kermani1, Steven R Ytterberg, Kenneth J Warrington

  • 1Mayo Clinic, Rochester, Minnesota, USA. kermani.tanaz@mayo.edu

Arthritis Care & Research
|January 18, 2011
PubMed

Insights

Pneumocystis pneumonia (PCP) is a rare but serious infection in patients with giant cell arteritis (GCA). This study highlights that PCP in GCA patients, often on prednisone, leads to significant hospitalizations and mortality, emphasizing the need for vigilance.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Pulmonology

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis often treated with corticosteroids.
  • Corticosteroid therapy can increase the risk of opportunistic infections like Pneumocystis pneumonia (PCP).
  • The co-occurrence of GCA and PCP is infrequently reported, necessitating a clearer understanding of its clinical impact.

Purpose of the Study:

  • To characterize the clinical presentation, laboratory findings, and outcomes of patients diagnosed with both GCA and PCP.
  • To evaluate the morbidity and mortality associated with PCP in the context of GCA.

Main Methods:

  • A retrospective review of medical records was conducted for patients diagnosed with GCA and PCP between 1976 and 2008.
  • Patient identification was based on International Classification of Diseases, Ninth Revision codes.
  • PCP diagnosis was confirmed by the identification of Pneumocystis jiroveci organisms.

Main Results:

  • Seven patients with biopsy-proven GCA developed PCP, with a median time of 3 months from GCA diagnosis to PCP diagnosis.
  • All patients were on prednisone therapy (median 50 mg/day) and none received PCP prophylaxis.
  • PCP diagnosis was primarily via bronchoalveolar lavage (86%). High rates of hospitalization (100%), ICU admission (57%), and mechanical ventilation (43%) were observed, with a 29% mortality rate.

Conclusions:

  • Pneumocystis pneumonia is a rare but significant complication in patients with giant cell arteritis.
  • The infection is associated with substantial morbidity and mortality, particularly in patients requiring mechanical ventilation.
  • This underscores the importance of considering PCP in GCA patients presenting with respiratory symptoms, especially those on immunosuppressive therapy.
Abstract

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