e-ISSN 2147-2475
Journal of Psychiatric Nursing
Pneumocystis Pneumonia with Atypical Presentation in an HIV Seronegative Patient with Systemic Lupus Erythematosus during Steroid Therapy [Respir Case Rep]
Respir Case Rep. 2018; 7(2): 82-85 | DOI: 10.5505/respircase.2018.49379

Pneumocystis Pneumonia with Atypical Presentation in an HIV Seronegative Patient with Systemic Lupus Erythematosus during Steroid Therapy

Gina Amanda, Dianiati Kusumo Sutoyo
Department of Pulmonology and Respiratory Medicine Faculty of Medicine Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia

Pneumocystis pneumonia (PCP) is common among HIV patients, but it is rare in patients with autoimmune diseases such as systemic lupus erythematosus (SLE). Some of the risk factors related to PCP in SLE patients include a high steroid dose, greater disease activity, renal involvement, and lower lymphocyte and CD4+ counts. Described herein is the case of a 23-year-old female with SLE who was treated with high-dose steroid therapy. She was admitted to the clinic with a dry cough and a prolonged fever persisting since the tapering of the steroid dose. High-resolution computed tomography of the thorax revealed intraseptal thickening, subpleural nodules, and enlargement of the 4L, 6, and 7 lymph nodes. A laboratory examination of an induced sputum sample using polymerase chain reaction was positive for Pneumocystis jirovecii. Trimethoprim/sulfamethoxazole was administered for 14 days and clinical improvement was observed.

Keywords: CD4 lymphocyte, pneumocystis pneumonia, systemic lupus erythematosus.

Steroid Tedavisi Alan HIV Seronegatif Sistemik Lupus Eritematozisli Bir Hastada Atipik Görünümlü Pnömosistis Pnömonisi

Gina Amanda1, Dianiati Kusumo Sutoyo1

Pnömosistis pnömonisi (PP) HIV'li hastalarda sık görülürken sistemik lupus eritematozisli (SLE) gibi otoimmün hastalığı olanlarda nadirdir. Yüksek doz steriod kullanımı, ağır hastalık, böbrek tutulumu, lenfosit ve CD4+sayısında düşüklük gibi bazı nedenler SLE hastalarında PP için risk oluşturabilmektedir. Burada, yüksek doz steroid tedavi alan SLE'li 23 yaşındaki kadın olgu sunulmuştur. Steroid dozu azaltıldığı sırada kuru öksürük ve devam eden ateş yakınmaları ile kliniğe yatırıldı. Yüksek çözünürlüklü toraks tomografisinde, intraseptal kalınlaşmalar, subplevral nodüller ve 4L, 6 ve 7 nolu lenf nodlarında büyüme saptandı. İndükte balgam örneğinin PCR ile yapılan incelemesinde Pneumocystis jirovecii pozitif bulundu. Trimetoprim/Sülfametaksazol tedavisi 14 gün uygulandı ve klinik iyileşme gözlendi.

Anahtar Kelimeler: CD lenfosit, pnömositis pnömonisi, sistemik lupus eritematozis

Gina Amanda, Dianiati Kusumo Sutoyo. Pneumocystis Pneumonia with Atypical Presentation in an HIV Seronegative Patient with Systemic Lupus Erythematosus during Steroid Therapy. Respir Case Rep. 2018; 7(2): 82-85

Corresponding Author: Gina Amanda, Indonesia
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