BACKGROUND Pneumocystis jiroveci pneumonia(PJP)is a serious opportunistic infection that occurs mostly in patients with immunodeficiency and long-term immunosuppressive therapy.In non-human immunodeficiency virus-infe...BACKGROUND Pneumocystis jiroveci pneumonia(PJP)is a serious opportunistic infection that occurs mostly in patients with immunodeficiency and long-term immunosuppressive therapy.In non-human immunodeficiency virus-infected patients,the most important risk factor for PJP is the use of glucocorticoids in combination with other immunosuppressive treatments.The management of glucocorticoids during the perioperative period in patients with dermatomyositis requires special care.CASE SUMMARY We report a case of PJP in the perioperative period.A 61-year-old woman with a history of anti-melanoma differentiation-associated gene 5(MDA5)-positive dermatomyositis and interstitial pneumonia was administered with long-term oral methylprednisolone and cyclosporine.The patient underwent right total hip arthroplasty in the orthopaedic department for bilateral osteonecrosis of the femoral head.She was given intravenous drip hydrocortisone before anesthesia and on the first day after surgery and resumed oral methylprednisolone on the second postoperative day.On the fifth day after surgery,the patient suddenly developed dyspnea.The computed tomography scan showed diffuse grid shadows and ground glass shadows in both lungs.Polymerase chain reaction testing of bronchoalveolar lavage fluid was positive for Pneumocystis jiroveci.The patient was eventually diagnosed with PJP and was administered with oral trimethoprim-sulfamethoxazole.At the 6-mo review,there was no recurrence or progression.CONCLUSION Continued perioperative glucocorticoid use in patients with anti-MDA5-positive dermatomyositis may increase the risk of PJP.展开更多
The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis(RA),which is reported to occur in up to 60%to 80%of RA patients.Respiratory complications are the second leading cause of de...The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis(RA),which is reported to occur in up to 60%to 80%of RA patients.Respiratory complications are the second leading cause of death due to RA.Although there is a wide spectrum of RA-associated respiratory diseases,interstitial lung disease is the most common manifestation and it impacts the prognosis of RA.There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease(RA-ILD)and RA-associated respiratory diseases recently,for example,opportunistic pulmonary infectious diseases and toxicity from RA therapies.From a chest physicians’perspective,we will update the diagnosis and treatment of RA-associated ILD,methotrexate-associated lung disease,and the complication of Pneumocystis jiroveci pneumonia in RA in this review.展开更多
基金Supported by National Natural Science Foundation of China,No. 81673776, and No. 82072494
文摘BACKGROUND Pneumocystis jiroveci pneumonia(PJP)is a serious opportunistic infection that occurs mostly in patients with immunodeficiency and long-term immunosuppressive therapy.In non-human immunodeficiency virus-infected patients,the most important risk factor for PJP is the use of glucocorticoids in combination with other immunosuppressive treatments.The management of glucocorticoids during the perioperative period in patients with dermatomyositis requires special care.CASE SUMMARY We report a case of PJP in the perioperative period.A 61-year-old woman with a history of anti-melanoma differentiation-associated gene 5(MDA5)-positive dermatomyositis and interstitial pneumonia was administered with long-term oral methylprednisolone and cyclosporine.The patient underwent right total hip arthroplasty in the orthopaedic department for bilateral osteonecrosis of the femoral head.She was given intravenous drip hydrocortisone before anesthesia and on the first day after surgery and resumed oral methylprednisolone on the second postoperative day.On the fifth day after surgery,the patient suddenly developed dyspnea.The computed tomography scan showed diffuse grid shadows and ground glass shadows in both lungs.Polymerase chain reaction testing of bronchoalveolar lavage fluid was positive for Pneumocystis jiroveci.The patient was eventually diagnosed with PJP and was administered with oral trimethoprim-sulfamethoxazole.At the 6-mo review,there was no recurrence or progression.CONCLUSION Continued perioperative glucocorticoid use in patients with anti-MDA5-positive dermatomyositis may increase the risk of PJP.
基金supported by the National High Level Hospital Clinical Research Funding(No.2022-PUMCHA-009)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2019XK320037).
文摘The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis(RA),which is reported to occur in up to 60%to 80%of RA patients.Respiratory complications are the second leading cause of death due to RA.Although there is a wide spectrum of RA-associated respiratory diseases,interstitial lung disease is the most common manifestation and it impacts the prognosis of RA.There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease(RA-ILD)and RA-associated respiratory diseases recently,for example,opportunistic pulmonary infectious diseases and toxicity from RA therapies.From a chest physicians’perspective,we will update the diagnosis and treatment of RA-associated ILD,methotrexate-associated lung disease,and the complication of Pneumocystis jiroveci pneumonia in RA in this review.
