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1.
Eur J Radiol ; 116: 116-127, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153552

RESUMO

Pneumocystis jirovecii pneumonia (PJP) has emerged as a main issue in non Human Immunodeficiency Virus (HIV) immunocompromised hosts, exposing patients to high mortality rates, especially when the diagnosis is delayed. Since microbiological confirmation is often unfeasible or difficult to obtain, High-resolution Computed Tomography (HRCT) represents a main tool for guiding the diagnosis in the appropriate clinical scenario. Nevertheless, radiologists must be aware that PJP at HRCT is a multifaceted process, with a variety of common and less frequent findings, along with a broad spectrum of infectious (e.g., viral and certain fungal and bacterial pneumonias) and non-infectious (e.g., pulmonary oedema, diffuse alveolar haemorrhage, and drug toxicity) differential diagnoses. In this review we resume background clinical information on PJP in non-HIV immunocompromised patients, illustrate both typical and less frequent HRCT findings, and present the spectrum of infectious and non-infectious mimickers at HRCT, highlighting the similarities with PJP and providing clues for the differential diagnosis.


Assuntos
Hospedeiro Imunocomprometido/fisiologia , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino
2.
BMC Med Imaging ; 19(1): 39, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113389

RESUMO

BACKGROUND: Pulmonary involvement is common in several infectious and non-infectious diagnostic settings. Imaging findings consistently overlap and are therefore difficult to differentiate by chest-CT. The aim of this study was to evaluate the role of CT-textural features(CTTA) for discrimination between atypical viral (respiratory-syncitial-virus(RSV) and herpes-simplex-1-virus (HSV1)), fungal (pneumocystis-jirovecii-pneumonia(PJP)) interstitial pneumonias and alveolar hemorrhage. METHODS: By retrospective single-centre analysis we identified 46 consecutive patients (29 m) with RSV(n = 5), HSV1(n = 6), PJP(n = 21) and lung hemorrhage(n = 14) who underwent unenhanced chest CTs in early stages of the disease between 01/2016 and 02/2017. All cases were confirmed by microbiologic direct analysis of bronchial lavage. On chest-CT-scans, the presence of imaging features like ground-glass opacity(GGO), crazy-paving, air-space consolidation, reticulation, bronchial wall thickening and centrilobular nodules were described. A representative large area was chosen in both lungs and used for CTTA-parameters (included heterogeneity, intensity, average, deviation, skewness). RESULTS: Discriminatory CTTA-features were found between alveolar hemorrhage and PJP consisting of differences in mean heterogeneity(p < 0.015) and uniformity of skewness(p < 0.006). There was no difference between CT-textural features of diffuse alveolar hemorrhage and viral pneumonia or PJP and viral pneumonia. Visual HRCT-assessment yielded great overlap of imaging findings with predominance of GGO for PJP and airspace consolidation for pneumonia/alveolar hemorrhage. Significant correlations between HRCT-based imaging findings and CT-textural features were found for all three disease groups. CONCLUSION: CT-textural features showed significant differences in mean heterogeneity and uniformity of skewness. HRCT-based imaging findings correlated with certain CT-textural features showing that the latter have the potential to characterize structural properties of lung parenchyma and related abnormalities.


Assuntos
Hemorragia/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/isolamento & purificação , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
3.
Aust Vet J ; 97(5): 162-165, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31025329

RESUMO

CASE REPORT: A 7-year-old female-neutered Maltese Terrier × Papillon dog was presented with tachypnoea and weight loss following 12 months of therapy with toceranib phosphate for a metastatic, histologically-low-grade mast cell tumour. The dog was diagnosed with Pneumocystis canis based on PCR with supportive clinical, radiographic and cytological findings. No other clinical evidence of immunocompromise was identified through assessment of haematology and immunoglobulin quantification. Clinical signs completely resolved with a short course of potentiated sulfonamides and discontinuation of the toceranib. CONCLUSION: To the authors' knowledge this represents the first case of Pneumocystis in a dog secondary to immunomodulatory drug therapy. It is also the first case of opportunist infection secondary to a tyrosine kinase inhibitor in dogs.


Assuntos
Doenças do Cão/induzido quimicamente , Indóis/efeitos adversos , Pneumonia por Pneumocystis/veterinária , Pirróis/efeitos adversos , Animais , Cães , Combinação de Medicamentos , Feminino , Sarcoma de Mastócitos/tratamento farmacológico , Sarcoma de Mastócitos/veterinária , Pneumonia por Pneumocystis/induzido quimicamente , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/tratamento farmacológico , Sulfadoxina/uso terapêutico , Resultado do Tratamento , Trimetoprima/uso terapêutico
6.
BMC Pulm Med ; 19(1): 47, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30791907

RESUMO

BACKGROUND: In patients with non-HIV Pneumocystis jirovecii pneumonia (PjP), computed tomography imaging reveals ground grass opacities (GGO). Previous reports show that some patients with non-HIV PjP exhibit GGO with crazy paving. However, there have been no studies on the association between crazy paving GGO and non-HIV PjP clinical outcomes. Here, at the diagnosis of non-HIV PjP, we reviewed high-resolution computed tomography (HRCT) findings that included GGO types and evaluated the prognostic impact of crazy paving GGO on the clinical outcomes of non-HIV PjP immunocompromised patients. METHODS: We retrospectively reviewed the clinical information including the HRCT findings of patients diagnosed with non-HIV PjP from five institutions between 2006 and 2015. The GGO types included those with or without crazy paving. The associations between clinical factors such as HRCT findings and in-hospital mortality were assessed using the Cox regression model. RESULTS: Sixty-one patients were included in our study. Nineteen patients died at a hospital. All patients exhibited GGO on HRCT imaging at diagnosis of non-HIV PjP. The HRCT findings included crazy paving GGO (29 patients, 47.5%), consolidations (23 patients, 37.7%), bronchiectasis (14 patients, 23.0%), and centrilobular small nodules (30 patients, 49.2%). Cysts were not observed in any patient. Multivariate analysis revealed that crazy paving GGO and low serum albumin levels were independent risk factors for mortality. CONCLUSIONS: At the diagnosis of non-HIV PjP, patients with crazy paving GGO on HRCT imaging and low serum albumin levels may have a poor prognosis.


Assuntos
Mortalidade Hospitalar , Pulmão/diagnóstico por imagem , Pneumonia por Pneumocystis/diagnóstico por imagem , Corticosteroides/efeitos adversos , Idoso , Antineoplásicos/efeitos adversos , Doenças Autoimunes/imunologia , Estudos de Coortes , Doenças do Tecido Conjuntivo/imunologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/imunologia , Pneumonia por Pneumocystis/imunologia , Pneumonia por Pneumocystis/metabolismo , Pneumonia por Pneumocystis/mortalidade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Albumina Sérica/metabolismo , Tomografia Computadorizada por Raios X
8.
Am J Emerg Med ; 37(1): 176.e3-176.e4, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30287130

RESUMO

We present the case of a human immunodeficiency virus (HIV)-infected patient who arrived at our emergency department with fever, headache and exertional dyspnea. Throughout their stay, a chest x-ray was taken and a rounded opacity in his left lung was observed. CT images showed same abnormality and also ground glass opacities were seen. Symptoms and images strongly suggested a pulmonary infection due to pneumocystis jirovecii, however a presence of a round lesion should always lead to neoplasia being suspected. We empirically started treatment based on trimethoprim and sulfamethoxazole. Once available, flexible bronchoscopy and bronchoalveolar lavage was performed and stained preparations from his respiratory specimens confirmed the diagnosis of pulmonary pneumocystis infection. Finally, after 4 days of antibiotic therapy, an important clinical improvement was documented; a new chest x-ray was performed and the previous rounded opacity was absent. This finding strongly suggested a case of round pneumonia.


Assuntos
Infecções por HIV/complicações , Pulmão/diagnóstico por imagem , Pneumocystis carinii , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico por imagem , Adulto , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pneumonia por Pneumocystis/tratamento farmacológico , Radiografia Torácica , Tomografia Computadorizada por Raios X , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
9.
Saudi J Kidney Dis Transpl ; 29(4): 993-996, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30152442

RESUMO

We describe a patient who had developed hypercalcemic crisis, with altered mental status and renal failure, one year following aggressive corticosteroid-therapy for lupus nephritis. Her disease relapsed after successful live-related kidney transplantation 11 years ago. She had normal parathyroid hormone and 25-hydroxyvitamin D yet high 1,25 dihydroxyvitamin D. Four weeks later, she developed severe dyspnea and hypoxia with a reticulonodular pattern on chest computed tomography. Bacteriological and serological tests were negative for pathogens. However, bronchoalveolar lavage established the diagnosis of Pneumocystis jiroviceii pneumonia (PJP). Her pneumonia and hypercalcemia improved with Co-trimoxazole. The case indicates that severe hypercalcemia can herald PJP.


Assuntos
Hipercalcemia , Pneumonia por Pneumocystis , Corticosteroides/uso terapêutico , Adulto , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/fisiopatologia , Hospedeiro Imunocomprometido , Transplante de Rim , Pulmão/diagnóstico por imagem , Pulmão/patologia , Nefrite Lúpica/tratamento farmacológico , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/patologia , Radiografia Torácica , Tomografia Computadorizada por Raios X
10.
Clin Rheumatol ; 37(8): 2269-2274, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29876690

RESUMO

To compare Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA) with PCP in patients with non-RA connective tissue diseases (CTDs) in order to clarify the characteristics of the former. We extracted consecutive patients satisfying the following criteria for "clinical PCP": (1) positive plasma ß-D-glucan, (2) PCP-compatible computed tomography findings of the lung, and (3) successful treatment with antipneumocystic antibiotics. Patients who underwent methylprednisolone "pulse" therapy or sufficient antibiotics to cure bacterial pneumonia were excluded. We used the t test, U test, or Fischer's exact probability test to compare the two groups and Jonckheere-Terpstra's test and Ryan's procedure for the trend test. Thirty-five cases were extracted. The underlying rheumatic diseases were RA in 25 and non-RA CTDs in ten. At the onset of clinical PCP, the lymphocyte counts were 884 vs 357/mm3 (p < 0.001), PC-PCR positivity 64% vs 100% (p = 0.029), glucocorticoid dose 4.0 vs 17.5 mg PSL/day (p < 0.001), and methotrexate dose 8 vs 0 mg/week (p = 0.003). The PC-PCR-negative patients, observed only in the RA group, were all receiving methotrexate (MTX) therapy except one patient who was receiving high-dose prednisolone alone. All PC-PCR-positive patients were receiving glucocorticoid, TNF inhibitor, or a non-MTX immunosuppressant. No patient with MTX alone had positive PC-PCR results. Clinical PCP in RA patients differed from that in non-RA CTD patients and may be understood as only a part of the rheumatoid-specific interstitial lung injury spectrum influenced by multiple, synergistic factors including MTX, Pneumocystis, and RA itself.


Assuntos
Artrite Reumatoide/complicações , Doenças do Tecido Conjuntivo/complicações , Imunossupressores/administração & dosagem , Doenças Pulmonares Intersticiais/complicações , Pneumonia por Pneumocystis/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Artrite Reumatoide/microbiologia , Doenças do Tecido Conjuntivo/microbiologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , beta-Glucanas/sangue
11.
BMJ Case Rep ; 20182018 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-29680792

RESUMO

We present a case of a 57-year-old woman who contracted Pneumocystis jiroveci pneumonia while on Benepali, the biosimilar version of etanercept for rheumatoid arthritis. She had seropositive erosive disease. She was admitted to clinic with a 2-week history of dyspnoea, dry cough and fever. Her initial examination showed her to be hypoxic on air with saturations of 77% and left basal crackles. Her admission chest X-ray showed fine reticular shadowing, with an initial suspicion of pulmonary fibrosis. She was empirically treated for community-acquired pneumonia but continued to deteriorate with a worsening type 1 respiratory failure. She was intubated and ventilated on intensive care. The suspicion was raised of P. jiroveci pneumonia given her immunosuppression, hypoxic presentation and chest X-ray changes. This was confirmed on sputum PCR. She was treated with a 3-week course of steroids and co-trimoxazole. She was discharged home after a 2-week admission.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Etanercepte/efeitos adversos , Pneumonia por Pneumocystis/diagnóstico por imagem , Antibacterianos/uso terapêutico , Artrite Reumatoide/complicações , Diagnóstico Diferencial , Combinação de Medicamentos , Feminino , Humanos , Imunossupressores/efeitos adversos , Injeções Subcutâneas , Unidades de Terapia Intensiva , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/tratamento farmacológico , Radiografia Torácica/métodos , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia , Escarro/metabolismo , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
12.
Medicine (Baltimore) ; 97(12): e0162, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29561424

RESUMO

RATIONALE: Cognitive dysfunction is a common presenting symptom in patients with HIV/AIDS. It is usually directly associated with HIV infection or due to opportunistic infection. Rapidly progressive dementia, however, is rarely observed in acute HIV infection or during immune reconstitution. Recently, a case of Creutzfeld-Jakob disease (CJD) has been reported in a patient with chronic HIV infection. The incidence of CJD is not known to be increased among immunocompromised patients. PATIENT CONCERNS: We here report the case of a 59-year-old male patient with a recent diagnosis of HIV/AIDS and Pneumocystis jiroveci pneumonia presenting with secondary behavioral changes and disorientation. Over the course of several weeks, progressive dementia developed characterized by apraxia, gait ataxia, and mutism. DIAGNOSES: After the exclusion of common HIV-associated neurologic conditions, the clinical course as well as findings on electroencephalogram (EEG), magnetic resonance imaging (MRI), and a positive 14-3-3 assay converged into a probable diagnosis of CJD. The diagnosis was later confirmed histopathologically. OUTCOMES: Palliative care was provided, and the patient passed away within 2 months of symptom onset. LESSONS: HIV/AIDS is an important stratifying condition during the work-up of many clinical syndromes including encephalopathy but may prematurely exclude important differential diagnoses. Non-opportunistic etiologies have to be considered as part of a secondary workup as this case of concomitant AIDS and CJD demonstrates. Rapidly progressive dementia should be distinguished from delirium as early as possible in order to be able to choose the correct diagnostic pathway. Despite the common occurrence of neurologic syndromes in the setting of immunodeficiency, an analytical diagnostic approach is advisable to minimize diagnostic bias.


Assuntos
Síndrome de Creutzfeldt-Jakob/etiologia , Infecções por HIV/complicações , Pneumocystis carinii , Pneumonia por Pneumocystis/complicações , Síndrome de Creutzfeldt-Jakob/diagnóstico por imagem , Síndrome de Creutzfeldt-Jakob/fisiopatologia , Síndrome de Creutzfeldt-Jakob/terapia , Evolução Fatal , Infecções por HIV/diagnóstico por imagem , Infecções por HIV/fisiopatologia , Infecções por HIV/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/fisiopatologia , Pneumonia por Pneumocystis/terapia
13.
An Bras Dermatol ; 92(3): 401-403, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29186259

RESUMO

Methotrexate has immunosuppressive effects and is administered for refractory chronic urticaria. We present a case of Pneumocystis jirovecii pneumonia in a patient with refractory chronic urticaria managed by low-dose weekly methotrexate treatment (total cumulative dose 195mg). Our study highlights the importance of providing prompt diagnosis and treatment of Pneumocystis jirovecii pneumonia in patients with chronic urticaria under methotrexate therapy.


Assuntos
Fármacos Dermatológicos/efeitos adversos , Metotrexato/efeitos adversos , Pneumocystis carinii , Pneumonia por Pneumocystis/induzido quimicamente , Adulto , Doença Crônica , Fármacos Dermatológicos/administração & dosagem , Feminino , Humanos , Metotrexato/administração & dosagem , Pneumonia por Pneumocystis/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Urticária/tratamento farmacológico
15.
BMJ Case Rep ; 20172017 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-28978595

RESUMO

Patients with pneumocystis pneumonia have a risk of progressing to acute respiratory failure necessitating admission to intensive care. The case described is of a patient with a newly diagnosed HIV infection presenting with pneumocystis pneumonia. Despite initiating the appropriate pharmacological treatment the patient's clinical condition deteriorated, and required both rescue pharmacological therapy with echinocandins as well as respiratory support with extracorporeal membrane oxygenation therapy. The patient recovered well on ventilator and circulatory support despite a long weaning process complicated by sequelae common to pneumocystis pneumonia. Following initialisation of antiretroviral therapy and step-down from an intensive care setting, the patient required further prolonged hospital stay for rehabilitation and mental health support before being discharged. This case reviews the novel pharmacological therapies and respiratory support strategies used in cases of pneumocystis pneumonia, including the clinical and psychological sequelae that may follow.


Assuntos
Infecções por HIV/diagnóstico , Pneumonia por Pneumocystis/diagnóstico , Antirretrovirais/administração & dosagem , Antirretrovirais/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Tosse/etiologia , Diagnóstico Diferencial , Quimioterapia Combinada , Equinocandinas/administração & dosagem , Equinocandinas/uso terapêutico , Oxigenação por Membrana Extracorpórea , Feminino , Febre/etiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/tratamento farmacológico , Tomografia Computadorizada por Raios X
16.
J Pediatric Infect Dis Soc ; 6(suppl_1): S22-S31, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28927203

RESUMO

Invasive fungal disease (IFD) is a life-threatening condition, especially in immunocompromised children. The role of diagnostic imaging in children at risk for an IFD is multifactorial, including initially detecting it, evaluating for dissemination of infection beyond the primary site of disease, monitoring the response to antifungal therapy, and assessing for potential relapse. The objective of this review was to synthesize the published literature relevant to the use of various imaging modalities for the diagnosis and management of IFD in children.


Assuntos
Candidíase Invasiva/diagnóstico por imagem , Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Aspergilose Broncopulmonar Alérgica/diagnóstico por imagem , Blastomicose/diagnóstico por imagem , Doenças Ósseas Infecciosas/diagnóstico por imagem , Doenças Ósseas Infecciosas/microbiologia , Criança , Coccidioidomicose/diagnóstico por imagem , Infecções Oculares Fúngicas/diagnóstico por imagem , Histoplasmose/diagnóstico por imagem , Humanos , Hospedeiro Imunocomprometido , Hepatopatias/diagnóstico por imagem , Hepatopatias/microbiologia , Pneumopatias Fúngicas/diagnóstico por imagem , Meningoencefalite/diagnóstico por imagem , Meningoencefalite/microbiologia , Mucormicose/diagnóstico por imagem , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/microbiologia , Pneumonia/diagnóstico por imagem , Pneumonia/microbiologia , Pneumonia por Pneumocystis/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Sinusite/microbiologia , Esplenopatias/diagnóstico por imagem , Esplenopatias/microbiologia
17.
Gan To Kagaku Ryoho ; 44(9): 783-785, 2017 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-28912409

RESUMO

A 47-year-old woman received adjuvant chemotherapy for breast cancer. On the 13th day of 4 courses of dose-dense AC therapy, she developed a fever. She was orally administered an antibioticfor febrile neutropenia treatment. She showed no improvement of symptoms and gradually presented with new symptoms, including a non-productive cough and dyspnea. After admission, she underwent a further examination, and was provided a diagnosis of pneumocystis pneumonia. It is reported that patients receiving chemotherapy for solid tumors are less likely to develop opportunistic infections. However, patients receiving dose-dense chemotherapy may have a higher risk for developing opportunistic infections than those receiving conventional chemotherapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama , Pneumonia por Pneumocystis/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/tratamento farmacológico , Tomografia Computadorizada por Raios X
19.
Mult Scler Relat Disord ; 14: 1-3, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28619423

RESUMO

We present the case of a 54 year old woman with known relapsing-remitting multiple sclerosis who presented with acute respiratory deterioration five weeks after a first course of alemtuzumab. Imaging showed bilateral ground glass changes and extensive investigations confirmed chest infection with dual pathogens - Pneumocystis jirovecii and Cytomegalovirus. She responded to standard anti-PJP and CMV therapy and was discharged on oral prophylaxis. Opportunistic infections in the weeks immediately following alemtuzumab therapy remain an uncommon complication but one that requires clinical vigilance, careful monitoring and appropriate prophylactic therapy.


Assuntos
Alemtuzumab/efeitos adversos , Infecções por Citomegalovirus/induzido quimicamente , Imunossupressores/efeitos adversos , Linfopenia/induzido quimicamente , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Pneumonia por Pneumocystis/induzido quimicamente , Pneumonia Viral/induzido quimicamente , Síndrome do Desconforto Respiratório do Adulto/induzido quimicamente , Antineoplásicos Imunológicos/efeitos adversos , Coinfecção/induzido quimicamente , Coinfecção/diagnóstico por imagem , Infecções por Citomegalovirus/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
An. bras. dermatol ; 92(3): 401-403, May-June 2017. graf
Artigo em Inglês | LILACS | ID: biblio-886977

RESUMO

Abstract Methotrexate has immunosuppressive effects and is administered for refractory chronic urticaria. We present a case of Pneumocystis jirovecii pneumonia in a patient with refractory chronic urticaria managed by low-dose weekly methotrexate treatment (total cumulative dose 195mg). Our study highlights the importance of providing prompt diagnosis and treatment of Pneumocystis jirovecii pneumonia in patients with chronic urticaria under methotrexate therapy.


Assuntos
Humanos , Feminino , Adulto , Pneumonia por Pneumocystis/induzido quimicamente , Metotrexato/efeitos adversos , Pneumocystis carinii , Fármacos Dermatológicos/efeitos adversos , Pneumonia por Pneumocystis/diagnóstico por imagem , Urticária/tratamento farmacológico , Tomografia Computadorizada por Raios X , Metotrexato/administração & dosagem , Doença Crônica , Fármacos Dermatológicos/administração & dosagem
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