Atypical presentation of Pneumocystis jirovecii pneumonia in a patient with rheumatoid arthritis treated with tofacitinib: a case presentation

BMC Rheumatology

Rü¹  Ian F. J. Pirker²  Jacqueline Krane-Nuber²  diger Mü³  ller³  Werner C. Albrich⁴ 

[1] Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;Department of Rheumatology, Immunology and Rehabilitation, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;Division of Infectious Diseases &

关键词: Pneumocystis jirovecii pneumonia;    Rheumatoid arthritis;    Tofacitinib;    Hypercalcemia;   

DOI  :  10.1186/s41927-018-0042-7

学科分类：内科医学

来源: BioMed Central

【 摘 要 】

We report the case of a patient with rheumatoid arthritis (RA) treated with tofacitinib who developed severe Pneumocystis jirovecii pneumonia (PJP) with an atypical clinical presentation. A 78-year old male patient with RA treated with tofacitinib, methotrexate (MTX) and low dose corticosteroids was admitted to the hospital with arthralgia and nausea. Laboratory findings revealed hypercalcemia with normal levels of parathyroid hormone (PTH) and elevated 1,25-(OH)2 vitamin D levels. A lung CT scan showed bilateral interstitial pneumonic infiltrates. PCR from bronchoalveloar lavage was positive for Pneumocystis jirovecii. Hypercalcemia resolved under PJP treatment and was – after exclusion of other possible causes – probably fungal associated. Due to the increased risk of opportunistic infections in immunocompromised patients, the finding of hypercalcemia in conjunction with a pulmonary infection should raise high clinical suspicion of PJP.

【 授权许可】

CC BY