Pneumocystis jirovecii en paciente con artritis reumatoide

Abstract

Background: Pneumocystis pneumonia caused by Pneumocystis jirovecii is one of the most devastating fungal diseases in patients with impaired immunity. Effective antiviral therapies have reduced the burden of PJ in patients with AIDS, but increase in the prevalence of this disease among HIV-negative people receiving immunosuppressive treatments currently reported. Case report: Female 68, diabetic, hypertensive controlled, with 15 years of evolution of rheumatoid arthritis, managed with steroids and methotrexate, which has completed multiple hospitalizations in the last four months by lung disease characterized by dyspnea, dry cough and fever, TAC showing cryptogenic interstitial lung disease, with foci of consolidation and pulmonary fi brosis, transbronchial biopsy and PCR positive for Pneumocystis jirovecii. Handled with trimethoprim-sulfamethoxazole and steroid boluses, improving significantly in 11 days of hospitalization. Conclusions: Real-time PCR is a useful tool for the diagnosis of Pneumocystis pneumonia in non-HIV patients. Hence, a positive Pneumocystis real-time PCR should be taken into account even if the patient does not have symptoms, but has a risk factor like cancer, hematological disorder and/or receives an immunosuppressive therapy.