Gastroenterology Department, National Medical Center, Hospital de Especialidades, CMN Siglo XXI, IMSS, Mexico City, Mexico.
J Crohns Colitis. 2012 May;6(4):483-7. doi: 10.1016/j.crohns.2011.10.012. Epub 2011 Nov 23.
Pneumocystis jirovecii pneumonia (PCP) is a potential complication of immunosuppression. Crohn's disease (CD) is an immune granulomatous disorder characterized by transmural inflammation that can affect any part of the gastrointestinal tract. Its treatment is based on steroids and immunosuppressants but in non-responders, biologic compounds such as anti-tumor necrosis factor alpha (TNF) antibodies have been used. Neutralization of TNF causes a decrease in the inflammatory response but increases susceptibility to opportunistic infections such as fungal infections. We report a young male with chronic diarrhea, fever and weight loss who was diagnosed with CD and began conventional treatment with immunosuppressants, but due to lack of response after several weeks, biologic therapy with adalimumab was initiated. Seven weeks later he developed persistent fever and upper respiratory symptoms. After chest CT, bronchoscopy and bronchial lavage, P. jirovecii was identified by silver staining and confirmed by immunofluorescence. To our knowledge this is the second case of pneumocystosis associated with the use of adalimumab in CD and the first reported Mexican case confirmed by microbiological and immunological studies in this setting.
卡氏肺孢子虫肺炎（PCP）是免疫抑制的潜在并发症。克罗恩病（CD）是一种免疫肉芽肿性疾病，其特征是透壁性炎症，可影响胃肠道的任何部位。其治疗基于类固醇和免疫抑制剂，但在无反应者中，已使用生物化合物，如抗肿瘤坏死因子-α（TNF）抗体。TNF 的中和会导致炎症反应减少，但会增加对机会性感染（如真菌感染）的易感性。我们报告了一名患有慢性腹泻、发热和体重减轻的年轻男性，被诊断患有 CD，并开始接受免疫抑制剂的常规治疗，但由于数周后无反应，开始使用阿达木单抗进行生物治疗。7 周后，他出现持续发热和上呼吸道症状。在进行胸部 CT、支气管镜检查和支气管灌洗后，通过银染色和免疫荧光法鉴定出卡氏肺孢子虫。据我们所知，这是第二例与 CD 中使用阿达木单抗相关的肺孢子菌病病例，也是在这种情况下通过微生物学和免疫学研究证实的首例墨西哥病例。
