Perez-Ordoño L, Hoyo I, Sanclemente G, Ricart M J, Cofan F, Perez-Villa F, de la Bellacasa J Puig, Moreno A, Cervera C
Department of Infectious Diseases, Hospital Clinic de Barcelona-University of Barcelona, Barcelona, Spain.
Transpl Infect Dis. 2014 Apr;16(2):324-8. doi: 10.1111/tid.12184. Epub 2014 Jan 24.
Anti-Pneumocystis prophylaxis is recommended for at least 6-12 months after solid organ transplantation, as most cases of Pneumocystis jirovecii pneumonia (PCP) occur during the first year post transplantation. Herein, we report 4 cases of late-onset PCP (>1 year post transplant). PCP appeared in a range of 50-68 months post transplant. Two cases had history of humoral rejection episodes treated with rituximab, and the other 2 had low CD4+ T-cell count (<200 cells/mm(3) ) at the time of diagnosis. All 4 patients survived. In conclusion, although the number of cases is low, we must be aware of the possibility of late-onset PCP in solid organ transplant patients. The role of previous use of rituximab or persistent CD4+ T-cell lymphopenia should be addressed in future studies.
实体器官移植后至少6至12个月推荐进行抗肺孢子菌预防，因为大多数耶氏肺孢子菌肺炎（PCP）病例发生在移植后的第一年。在此，我们报告4例迟发性PCP（移植后>1年）病例。PCP出现在移植后50至68个月。2例有接受利妥昔单抗治疗的体液排斥发作史，另外2例在诊断时CD4 + T细胞计数低（<200个细胞/mm³）。所有4例患者均存活。总之，尽管病例数较少，但我们必须意识到实体器官移植患者发生迟发性PCP的可能性。既往使用利妥昔单抗或持续性CD4 + T细胞淋巴细胞减少的作用应在未来研究中加以探讨。
