Fact or Fiction: Does the Non-HIV/AIDS: Immunosuppressed Patient Need <i>Pneumocystis Jiroveci</i> Pneumonia Prophylaxis? An Updated Literature Review

Grewal, Parbeer; Brassard, Alain

doi:10.2310/7750.2009.09010

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…Diffuse alveolar haemorrhage has been described as a consequence of pulmonary histoplasmosis [77]. It should also be remembered that lung disease in GPA patients may also be due to concomitant infections, in particular Pneumocystis jirovecii infection in the immunocompromised patient [78, 79]. …”

Section: Lung Involvement In Childhood-onset Gpamentioning

confidence: 99%

Lung involvement in childhood onset granulomatosis with polyangiitis

et al. 2017

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Granulomatosis with polyangiitis is an ANCA-associated systemic vasculitis with a low incidence in the pediatric population. Lung involvement is a common manifestation in children affected by granulomatosis with polyangiitis, both at disease’s onset and during flares. Its severity is variable, ranging from asymptomatic pulmonary lesions to dramatic life-threatening clinical presentations such as diffuse alveolar haemorrhage. Several radiologic findings have been described, but the most frequent abnormalities detected are nodular lesions and fixed infiltrates. Interstitial involvement, pleural disease and pulmonary embolism are less common. Histology may show necrotizing or granulomatous vasculitis of small arteries and veins of the lung, but since typical features may be patchy, the site for lung biopsy should be carefully chosen with the help of imaging techniques such as computed tomography. Bronchoalveolar lavage is helpful to confirm the diagnosis of alveolar haemorrhage. Pulmonary function tests are frequently altered, showing a reduction in the diffusion capacity for carbon monoxide, which can be associated with obstructive abnormalities related to airway stenosis. Nodular lung lesions tend to regress with immunosuppressive therapy, but lung disease may also require second line treatments such as plasmapheresis. In cases of massive diffuse alveolar haemorrhage, ventilator support is crucial in the management of the patient.

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Section: Lung Involvement In Childhood-onset Gpamentioning

confidence: 99%

Lung involvement in childhood onset granulomatosis with polyangiitis

et al. 2017

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“…28 Given this low incidence, and that medications used for PCP prophylaxis have risks, prophylaxis may be reserved for patients with additional risk factors (discussed earlier). 28,50 First-line prophylaxis regimens include trimethoprim-sulfamethoxazole double strength by mouth daily or once 3 times weekly. Alternate regimens include dapsone 50 mg by mouth twice daily or 100 mg by mouth daily, atovaquone 1500 mg by mouth daily, or pentamidine 300 mg aerosol inhaled monthly via nebulizer.…”

Section: Seek Medical Interventions Early If Infection Is Suspectedmentioning

confidence: 99%

Infection and Infection Prevention in Patients Treated with Immunosuppressive Medications for Autoimmune Bullous Disorders

Lehman¹,

Murrell²,

Camilleri³

et al. 2011

Dermatologic Clinics

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“…Current recommendations encourage the use of co-trimoxazole as PCP chemoprophylaxis following induction therapy [7,8] as well as in maintenance therapy in GPA [9,10]. Acceptance rate of this recommendation still needs to be improved [11,12]. Here, we report a case of progressive GPA complicated by cyclophosphamide cardiotoxicity and infections including PCP.…”

Section: Introductionmentioning

confidence: 99%

A case of granulomatosis with polyangiitis complicated by cyclophosphamide toxicity and opportunistic infections: choosing between Scylla and Charybdis

2014

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BackgroundWe report a case of progressive Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) with life-threatening complications of both the underlying disease and induction immunosuppressive therapy. Here, for the first time, cyclophosphamide toxicity and severe opportunistic infections including pneumocystis jirovecii- pneumonia were found in one case in a close temporal relationship.Case presentationA 34-year-old male patient of Caucasian ethnicity presented with acute renal failure necessitating hemodialysis treatment due to Granulomatosis with Polyangiitis (Wegener’s Granulomatosis). Kidney disease progressed to end-stage renal disease shortly after first diagnosis. After the 2nd bolus of cyclophosphamide shortly, induction immunosuppression (glucocorticoid/cyclophosphamide) was interrupted for repeat infections and resumed 5 years later. By that time, the lungs developed large pulmonary cavernae most likely due to smoldering granuloma indicative for the failed goal of disease remission. Therefore, induction immunosuppression was resumed. Following two monthly boli of cyclophosphamide, the patient developed pericardial effusion and, consecutively, atrioventricular blockade most likely due to cyclophosphamide. After recovery, the patient was discharged without cotrimoxacole. 10 weeks after the last cyclophosphamide bolus and 6 weeks after cessation of cotrimoxacole, the patient was readmitted to the intensive-care unit with Pneumocystis jirovecii pneumonia, and died 6 months later or 74 months after first diagnosis of Granulomatosis with Polyangiitis.ConclusionsThis case illustrates both the need for adequate immunosuppressive therapy to reach disease remission and the limitations thereof in terms of complications including cardiotoxicity of cyclophosphamide and Pneumocystis jirovecii pneumonia. In line with current recommendations, the present case strongly encourages pneumocystis jirovecii- pneumonia chemoprophylaxis for at least 6 months following induction therapy in Granulomatosis with Polyangiitis.

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Fact or Fiction: Does the Non-HIV/AIDS: Immunosuppressed Patient Need Pneumocystis Jiroveci Pneumonia Prophylaxis? An Updated Literature Review

Cited by 9 publications

References 29 publications

Lung involvement in childhood onset granulomatosis with polyangiitis

Lung involvement in childhood onset granulomatosis with polyangiitis

Infection and Infection Prevention in Patients Treated with Immunosuppressive Medications for Autoimmune Bullous Disorders

A case of granulomatosis with polyangiitis complicated by cyclophosphamide toxicity and opportunistic infections: choosing between Scylla and Charybdis

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