“…Previously proposed risk factors for PCP in patients with connective tissue disease already susceptible to opportunistic infection from immunosuppressive medication include use of systemic corticosteroids, 2,3,23,24 particularly with a daily prednisone dose of 16 mg or higher for 8 weeks or longer 3 ; cytotoxic agents (cyclophosphamide 2,8 more than methotrexate 2,8,23 ); lack of PCP prophylaxis 23 ; advanced age 4 ; high degree of disease activity 24 ; pulmonary disease, 4,16 such as interstitial pulmonary fibrosis 16,25 ; leukopenia 2,24,26 ; CD4 1 lymphocyte counts less than 0.3 3 10 9 /L 24,26 ; and hypoalbuminemia. 27 The patient in our study in whom PCP developed (in her 10th decade of life, not on PCP prophylaxis, and with severe pulmonary fibrosis and hypoalbuminemia) had at least 4 risk factors for PCP in addition to iatrogenic immunosuppression with prednisone (Table IV).…”