2002 Volume 112 Issue 14 Pages 1817-1825
We report two cases of Pneumocystis carinii pneumonia (PCP) that developed during steroid therapy for collagen disease. A 56-year-old woman was reducing her dose of prednisolone after pulse therapy for interstitial pneumonia with dermatomyositis. Suddenly, she developed high fever and dyspnea. Chest CT revealed bilateral interstitial shadows. The patient was diagnosed with PCP by bronchoalveolar lavage fluid (BALF). Despite treatment, she died of respiratory failure. A 48-year-old man had SLE for 11 years, but was in remission for 5 years. He was taking prednisolone 5~7.5mg/day and cyclophosphamide 50~100mg/day. He was hospitalized with a 39~40°C fever and general fatigue, but no other symptoms. Cultures revealed no infection, but plasma β-D-glucan level increased to 908.4pg/ml, and gallium scintigram showed a large bilateral fluid accumulation. These findings suggested PCP. BALF confirmed this diagnosis. CMV pneumonia was diagnosed by CMV antigenemia assay. Bactramin and ganciclovir were administered. We decreased and stopped administration of these drugs as his β-D-glucan, KL-6, and CMV antigenemia levels decreased. However, drug-related bone marrow suppression developed, and the patient died from DIC. These cases suggest that we consider the possible development of PCP when treating patients with collagen diseases with steroids or immunosuppressive drugs.
