Department of Internal Medicine, Hippokration General Hospital, Athens, Greece.
Rheumatol Int. 2024 Feb;44(2):363-367. doi: 10.1007/s00296-023-05483-3. Epub 2023 Oct 18.
Pneumocystis jirovecii pneumonia (PJP) is a potentially fatal type of pneumonitis, which may have devastating consequences. Typically, it occurs in immunocompromised patients, with the natural history varying depending on the presence or not of HIV infection. Staining and polymerase chain reaction (PCR) testing in induced sputum or bronchoalveolar lavage (BAL) is the cornerstone of the diagnosis, while trimethoprim-sulfamethoxazole is the treatment of choice. The etiological association of biologic agents with the occurrence of PJP is not entirely clear. Adalimumab is a fully human monoclonal anti-TNF-alpha antibody, which has been introduced relatively recently in the treatment of autoimmune inflammatory diseases, such as rheumatoid arthritis. In contrast to other biologic agents, such as Alemtuzumab or Infliximab, there are a small number of reports that support the drug's ability to trigger the occurrence of PJP. Hereby, we present a 53-year-old female patient with a medical history of rheumatoid arthritis on Adalimumab therapy, who developed PJP and we will discuss the main characteristics of PJP and the possible contribution of biologics to the occurrence of the infection.
卡氏肺孢子菌肺炎（PJP）是一种潜在致命性的肺炎，可能会产生毁灭性的后果。通常，它发生在免疫功能低下的患者中，其自然史因 HIV 感染的存在与否而有所不同。诱导痰或支气管肺泡灌洗（BAL）中的染色和聚合酶链反应（PCR）检测是诊断的基石，而甲氧苄啶-磺胺甲噁唑是首选治疗方法。生物制剂与卡氏肺孢子菌肺炎发生的病因学关联尚不完全清楚。阿达木单抗是一种全人源单克隆抗 TNF-α抗体，它在治疗自身免疫性炎症性疾病（如类风湿关节炎）中相对较新。与其他生物制剂（如阿仑单抗或英夫利昔单抗）不同，有少数报告支持该药物具有引发卡氏肺孢子菌肺炎发生的能力。在此，我们报告了一例 53 岁女性类风湿关节炎患者，接受阿达木单抗治疗后发生了卡氏肺孢子菌肺炎，我们将讨论卡氏肺孢子菌肺炎的主要特征以及生物制剂对感染发生的可能贡献。
