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Fulminant Pneumocystis carinii pneumonia in 4 patients with dermatomyositis

H Bachelez1, B Schremmer, J Cadranel

  • 1Institut de Recherche sur la Peau, Hôpital Saint-Louis, Paris, France.

Archives of Internal Medicine
|July 14, 1997
PubMed

Insights

Four patients without HIV developed severe Pneumocystis pneumonia (PCP) while on corticosteroid therapy for dermatomyositis. Early onset and rapid progression suggest increased PCP risk in these patients, questioning the need for primary prophylaxis.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Rheumatology

Background:

  • Corticosteroid therapy is commonly used for autoimmune conditions like dermatomyositis.
  • Pneumocystis pneumonia (PCP) is typically associated with human immunodeficiency virus (HIV) infection.
  • The risk of opportunistic infections can increase with immunosuppressive treatments.

Observation:

  • Four cases of PCP occurred in HIV-seronegative patients receiving corticosteroids for dermatomyositis between 1989 and 1996.
  • PCP onset was rapid after initiating immunosuppressive therapy, with a fulminant course in three patients.
  • Lymphopenia and low CD4/CD8 cell counts were noted before and during PCP in all affected patients.

Findings:

  • Patients without HIV receiving high-dose corticosteroids for dermatomyositis experienced severe PCP.
  • Early lymphopenia and reduced CD4/CD8 counts may indicate susceptibility to PCP in this population.
  • The incidence and severity of PCP appear elevated in non-HIV patients undergoing immunosuppressive therapy.

Implications:

  • These findings challenge the traditional understanding of PCP risk factors.
  • The study questions the necessity of primary PCP prophylaxis in connective tissue disease patients on high-dose corticosteroids.
  • Further research is warranted to evaluate prophylactic strategies for non-HIV immunocompromised individuals.

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