Cytomegalovirus pneumonia in a patient with rheumatoid arthritis treated with low dose methotrexate and prednisone.

Clerc, D; Brousse, C.; Mariette, Xavier; Bennet, Pascal; Bisson, M

doi:10.1136/ard.50.1.67-b

Cited by 30 publications

(13 citation statements)

References 5 publications

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“…P carinii pneumonia has been reported in association with methotrexate treatment in persons with RA (21,28,32-37), psoriatic arthritis (22), asthma (26), and malignancies treated with chemotherapy and/or transplantation (46). Other infections reported in RA patients receiving methotrexate include cryptococcosis (38), nocardiosis (23,24,27), herpes zoster (25,33), Listeria meningitis (28), herpes simplex hepatitis (29), cytomegalovirus pneumonia (30), and disseminated histoplasmosis (24).…”

Section: Discussionmentioning

confidence: 99%

Treatment of refractory rheumatoid arthritis with a chimeric ANTI‐CD4 monoclonal antibody

Moreland

Pratt

Bucy

et al. 1994

Arthritis & Rheumatism

111

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Objective. To evaluate CD4+ T cell counts of rheumatoid arthritis (RA) patients at 18 and 30 months after treatment with a chimeric anti‐CD4 monoclonal antibody (MAb), cM‐T412, in a phase I trial. Methods. Of the 25 RA patients who received the MAb, 23 were available for followup at 18 and 30 months. Levels of circulating CD4+ T cells were measured by flow cytometry. Results. Circulating CD4+ T cell levels in these 23 RA patients remained below normal at 18 and 30 months posttreatment. More profound CD4+ T cell depletion was noted in the higher‐dose groups (300 and 700 mg). Conclusion. Prolonged suppression of circulating CD4+ T cells was noted both in single‐infusion and multiple‐infusion groups 18 and 30 months after cM‐T412 treatment. The depression was more pronounced in patients who received multiple infusions of cM‐T412. The prolonged decrease in CD4+ T cell numbers suggests that the capacity to reconstitute CD4+ T cells in this patient population (treated with methotrexate) is limited. One patient, who was also receiving methotrexate and prednisone, died 18 months after receiving 100 mg of cM‐T412. No other significant adverse effects, in particular, no opportunistic infections, were reported in these 23 RA patients at 18 and 30 months of followup.

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Section: Discussionmentioning

confidence: 99%

Treatment of refractory rheumatoid arthritis with a chimeric ANTI‐CD4 monoclonal antibody

Moreland

Pratt

Bucy

et al. 1994

Arthritis & Rheumatism

111

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“…a Chest radiographs revealed bilateral ground-glass infiltrates and reticular shadows. b The shadows disappeared after treatment with prednisolone and trimethopurim/ sulfamethoxazole a b MTX is effective for RA are still unclear, many antiinflammatory and immunosuppressive actions, such as the inhibition of cellular proliferation, alterations in the lymphocyte subsets, a decreased cytokine production, the suppression of T-cell activation, and cell adhesion molecules, [1][2][3][4][5][6][7][8][9][10][11][12] have all been hypothesized to play a role. The concomitant use of nonsteroidal anti-inflammatory drugs, which can raise the plasma concentration of MTX by displacing it from albumin binding sites and impairing its renal excretion, could also have potentiated the MTX toxicity.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jiroveci pneumonia associated with low-dose methotrexate treatment for rheumatoid arthritis: report of two cases and review of the literature

et al. 2006

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Low-dose methotrexate (MTX) therapy is widely used for rheumatoid arthritis (RA) because of its favorable efficacy and toxicity profile. Although Pneumocystis jiroveci pneumonia (PCP) is most often seen in severely immunosuppressed patients, PCP complicating low-dose MTX therapy for RA has been reported to sometimes occur. We herein report two cases of patients who developed PCP during treatment with low-dose MTX, and discuss the importance of prophylaxis for this opportunistic infection.

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“…CMV pneumonia can occur even with low-dose MTX therapy (7). A CMV patient with ileitis taking prednisolone 60 mg daily for 1 month for systemic lupus erythematosus (8) and a CMV patient with colitis treated with prednisolone 10 to 30 mg daily for 2 years for systemic lupus erythematosus (9) were reported, suggesting that single corticosteroid therapy for connective tissue diseases can precipitate CMV re-activation, although the critical dose or duration of corticosteroid therapy that triggers the development of CMV reactivation remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Intestinal Perforation due to Concomitant Cytomegalovirus Infection during Treatment for Pneumocystis jirovecii Pneumonia in a Patient with Rheumatoid Arthritis

Ishiguro¹,

Takayanagi²,

Kawabata

et al. 2011

Intern. Med.

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A 78-year-old woman with rheumatoid arthritis treated with methotrexate and corticosteroid was admitted to our hospital for dry cough and dyspnea. She was diagnosed as having Pneumocystis pneumonia based on elevated beta-D-glucan and positive PCR analysis of bronchoalveolar lavage fluid for Pneumocystis jirovecii. We started trimethoprim-sulfamethoxazole and high-dose corticosteroid therapy. Her pulmonary lesions gradually improved; however, she developed perforation of the ileum and subsequently died from sepsis. Histology of the perforated site was compatible with cytomegalovirus enterocolitis.

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Cytomegalovirus pneumonia in a patient with rheumatoid arthritis treated with low dose methotrexate and prednisone.

Cited by 30 publications

References 5 publications

Treatment of refractory rheumatoid arthritis with a chimeric ANTI‐CD4 monoclonal antibody

Treatment of refractory rheumatoid arthritis with a chimeric ANTI‐CD4 monoclonal antibody

Pneumocystis jiroveci pneumonia associated with low-dose methotrexate treatment for rheumatoid arthritis: report of two cases and review of the literature

Intestinal Perforation due to Concomitant Cytomegalovirus Infection during Treatment for Pneumocystis jirovecii Pneumonia in a Patient with Rheumatoid Arthritis

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