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Consensus treatment guidelines urged for pneumocystis jirovecii pneumonia in SLE patients
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Although rare, Pneumocystis jirovecci pneumonia in systemic lupus erythematosus carries significant morbidity and high mortality, and clinical management would benefit from consensus antibiotic treatment guidelines for highest-risk patients, according to recent study results.
Researchers conducted a retrospective review of medical records for 858 patients with systemic lupus erythematosus (SLE) admitted to National Cheng Kung University Hospital from January 2000 to December 2011. Laboratory detection of Pneumocystis organisms defined a diagnosis of P. jirovecci pneumonia (PCP).
In two cases, identification of Pneumocystis organisms was based on lung biopsy; in three cases through bronchoalveolar lavage. Five patients (aged 30 to 50 years) were identified with a 0.6% incidence; all had lupus nephritis and lymphopenia with low CD4+ T-cell counts. None received chemoprophylactics against P. jirovecci infection. Previously, all patients had been treated with higher daily prednisolone dosages and concurrent biologics or immunosupressants.
PCP contributed to a 60% mortality rate.
“Regardless of growing evidence supporting the clinical efficacy of primary prophylaxis in HIV-negative [connective tissue diseases] for incidence-lowering, life-quality improvement, and cost reduction, the lack of consensus guidelines addressing prophylactic antibiotics against PCP in SLE clearly reflects the absence of large-scale prospective or interventional studies on this issue,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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