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.

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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 sýk görülürken sistemik lupus eritematozisli (SLE) gibi otoimmün hastalýðý olanlarda nadirdir. Yüksek doz steriod kullanýmý, aðýr hastalýk, böbrek tutulumu, lenfosit ve CD4+sayýsýnda düþüklük gibi bazý nedenler SLE hastalarýnda PP için risk oluþturabilmektedir. Burada, yüksek doz steroid tedavi alan SLE'li 23 yaþýndaki kadýn olgu sunulmuþtur. Steroid dozu azaltýldýðý sýrada kuru öksürük ve devam eden ateþ yakýnmalarý ile kliniðe yatýrýldý. Yüksek çözünürlüklü toraks tomografisinde, intraseptal kalýnlaþmalar, subplevral nodüller ve 4L, 6 ve 7 nolu lenf nodlarýnda büyüme saptandý. Ýndükte balgam örneðinin PCR ile yapýlan incelemesinde Pneumocystis jirovecii pozitif bulundu. Trimetoprim/Sülfametaksazol tedavisi 14 gün uygulandý ve klinik iyileþme gözlendi.

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

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