Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: A retrospective review and case–control study of 21 patients |
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| Authors: | Yukiko Komano Masayoshi Harigai Ryuji Koike Haruhito Sugiyama Jun Ogawa Kazuyoshi Saito Naoya Sekiguchi Masayuki Inoo Ikuko Onishi Hiroyuki Ohashi Fujio Amamoto Masayuki Miyata Hideo Ohtsubo Kazuko Hiramatsu Masahiro Iwamoto Seiji Minota Naoki Matsuoka Goichi Kageyama Kazuyoshi Imaizumi Hitoshi Tokuda Yasumi Okochi Koichiro Kudo Yoshiya Tanaka Tsutomu Takeuchi Nobuyuki Miyasaka |
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| Affiliation: | 1. Tokyo Medical and Dental University, Tokyo, Japan;2. Dr. Harigai has received honoraria (less than $10,000) from Mitsubishi Tanabe Pharma.;3. International Medical Center of Japan, Tokyo, Japan;4. University of Occupational and Environmental Health, Kitakyushu, Japan;5. Saitama Medical Center, Saitama Medical University, Kawagoe, Japan;6. Utazu Hama Clinic, Kagawa, Japan;7. Hamamatsu University School of Medicine, Hamamatsu, Japan;8. Kanto Rosai Hospital, Kawasaki, Japan;9. Fukushima Red Cross Hospital, Fukushima, Japan;10. Japanese Red Cross Society Kagoshima Hospital, Kagoshima, Japan;11. Dr. Ohtsubo has received speaking fees (less than $10,000) from Mitsubishi Tanabe Pharma.;12. Tokyo Metropolitan Fuchu General Hospital, Tokyo, Japan;13. Jichi Medical University, Shimotsuke, Japan;14. Dr. Iwamoto has received honoraria (less than $10,000) from Mitsubishi Tanabe Pharma.;15. Dr. Minota has received honoraria (less than $10,000) from Mitsubishi Tanabe Seiyaku.;16. Nagasaki Medical Hospital of Rheumatology, Ohmura, Japan;17. Kurashiki Central Hospital, Kurashiki, Japan;18. Nagoya University Graduate School of Medicine, Nagoya, Japan;19. Social Insurance Central General Hospital, Tokyo, Japan;20. Dr. Takeuchi has received speaking fees (more than $10,000) from Mitsubishi Tanabe Seiyaku.;21. Dr. Miyasaka has received speaking fees and honoraria (less than $10,000) from Mitsubishi Tanabe Seiyaku. |
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| Abstract: | Objective To establish proper management of Pneumocystis jiroveci pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with infliximab. PCP has been observed in 0.4% of patients with RA treated with infliximab in Japan. Methods Data from patients with RA (n = 21) who were diagnosed with PCP during infliximab treatment and from 102 patients with RA who did not develop PCP during infliximab therapy were collected from 14 rheumatology referral centers in Japan. A retrospective review of these patients and a case–control study to compare patients with and without PCP were performed. Results The median length of time from the first infliximab infusion to the development of PCP was 8.5 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 7.5 mg/day and 8 mg/week, respectively. Pneumocystis jiroveci was microscopically identified in only 2 patients, although the polymerase chain reaction test for the organism was positive in 20 patients. The patients with PCP had significantly lower serum albumin levels (P < 0.001) and lower serum IgG levels (P < 0.001) than the patients without PCP. Computed tomography of the chest in all patients with PCP revealed ground‐glass opacity either with sharp demarcation by interlobular septa or without interlobular septal boundaries. Sixteen of the 21 patients with PCP developed acute respiratory failure, but all survived. Conclusion PCP is a serious complication that may occur early in the course of infliximab therapy in patients with RA. For the proper clinical management of this infectious disease, physicians need to be aware of the possibility of PCP developing during infliximab therapy. |
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