Fatal Pneumocystis Carinii Pneumonia after Proctocolectomy in a Patient with Steroid-and Cyclosporine-Refractory Ulcerative Colitis : Report of a Case

Abstract

Continuous intravenous infusion of cyclosporine (CS) has been used to avoid total colectomy in patients with steroid-refractory ulcerative colitis (UC). One side effect of the combination of high-dose steroids and CS therapy is infectious complications due to immunosuppression. We report fatal postoperative Pneumocystis carinii (PC) pneumonia in a patient with UC who underwent restorative proctocolectomy because of a poor response to steroids and CS. The choice of total colectomy or CS therapy for severe steroid-refractory UC and the need for prophylactic use of sulfamethoxazole-trimethoprim against PC pneumonia is a matter of debate. However, patients who receive treatment with steroids and CS are at risk for immunosuppression and serious PC pneumonia.