[Pneumocystis carinii pneumonia in HIV-negative immunosuppressed patients].

During a period of 10 years 129 immunosuppressed HIV-negative patients were evaluated for pulmonary complications. A definite diagnosis could be established in 72 cases (56%): Pneumocystis carinii pneumonia (PCP) (25), pulmonary involvement of underlying disease (10), drug toxicity (8), mycobacterioses (6), bacterial pneumonias (5), aspergillosis (5), others (13). The underlying conditions in patients with PCP were: lymphatic neoplasias (11), immunosuppression after solid organ (9) and after bone marrow transplantation (3), cytotoxic therapy for lupus erythematodes (1) and carcinoma (1). In 8 of 9 transplant patients anti-rejection therapy preceded the episode of PCP. Six patients (24%) died from respiratory failure 1 to 25 days after diagnosis of PCP, despite mechanical ventilation in four. Two patients recovered completely after mechanical ventilation for 14 and 30 days respectively. The frequency of PCP has markedly increased during the last few years: 1981-1987: 2 cases (6%), 1988: 4 (14%), 1989: 8 (42%) and 1990: 11 (26%). This can hardly be explained by improved diagnostic sensitivity or an increased number of immunosuppressed patients. Apart from the use of more potent immunosuppressive agents, the increased prevalence of Pneumocystis carinii may play an important role.