This article is more than 5 years old. Information may no longer be current.
High-dose glucocorticoids linked to PCP infection in patients with autoimmune diseases
Click Here to Manage Email Alerts
Patients with autoimmune diseases who developed Pneumocystis jirovecii pneumonia were more likely to have taken high doses of glucocorticoids, according to recently published research.
Researchers used the Singapore General Hospital database to retrospectively identify patients who developed P. jirovecii pneumonia (PCP) who were also diagnosed with an autoimmune disease, including systemic lupus erythematosus (SLE), Sjögren’s syndrome, Evans syndrome, autoimmune thrombocytopenic purpura, antiphospholipid syndrome, mixed connective tissue disease, scleroderma, granulomatosis with polyangiitis (GPA), microscopic polyangiitis, Churg-Strauss syndrome, polyarteritis nodosa, Takayasu arteritis, giant cell arteritis, dermatomyositis, polymyositis, inclusion body myositis and Behçet’s disease.
Patients included in the study were hospitalized between January 2003 and December 2007 and had information available regarding glucocorticoid use in the prior 28 days. Patients with concurrent HIV/AIDS were excluded from the study.
Four cases of PCP infection were identified from 1,063 patients during the 5-year study period, yielding an incidence rate of 75 per 100,000 patients. Of the patients with PCP, three were administered high doses of glucocorticoids. Statistical analysis showed an incidence rate of four patients taking high doses of glucocorticoids per 1,000, or approximately one case per 250 patients with autoimmune diseases on high doses of glucocorticoids.
Fisher exact test showed a statistically significant relative risk of 19 in patients on high dosages vs. patients on low dosages, according to the researchers. Patients who developed PCP infections were also a median 10 years older than the group who did not receive glucocorticoids.
Two of the four patients, one with Evans syndrome and one with polymyositis and interstitial lung disease, died. Both required admission to an intensive care unit and manual ventilation before death. – by Shirley Pulawski
Disclosure: The authors have no relevant financial disclosures.
Click Here to Manage Email Alerts