A case of Pneumocystis pneumonia during receiving medication by steroid for autoimmune hepatitis

Abstract

We present the case of a 77-year-old Japanese woman who was referred to our department due to impaired liver function. She was diagnosed as autoimmune hepatitis, classified 'definite AIH' according to Simplified diagnostic criteria of the International Autoimmune Hepatitis Group including pathological findings. Administration of prednisolone was started from the dose of 40 mg and tapered by two weeks, which resulted in a decrease of serum ALT levels. However, she developed fever and cough at the dose of 25 mg prednisolone. She was diagnosed with Pneumocyctis pneumonia by polymerase chain reaction in induced sputum sample, and then she was successfully treated with trimethoprim-sulfanethoxazone.
Pneumocystis pneumonia is an opportunistic infection affecting patients with immunosuppression, and is a severe disease that can be life threatening for patients receiving immnosuppressive medication or/and steroid therapy. Today we gastroenterplogists use immunosuppressing drugs for more diseases, so we should take more attention for complication of Pneumocystis pneumonia.