• Philippe Ichai, Daniel Azoulay, Cyrille Feray, Faouzi Saliba, Fadi Antoun, Bruno Roche, Henri Bismuth, and Didier Samuel.
• Centre Hépato-Biliaire, Hôpital Paul Brousse, UPRES 1596, Université Paris Sud, Villejuif, France. philippe.ichai@pbr.ap-hop-paris.fr
• Gastroen Clin Biol. 2002 May 1; 26 (5): 532-4.

AbstractMost cases of infections described after steroid treatment for severe acute alcoholic hepatitis are of bacterial origin. However, the rate of bacterial infections in these patients is not higher than in those who are not treated by steroids. The opportunistic infections are even more rare. We report two cases of patients with cirrhosis and human immunodeficiency virus, treated for alcoholic hepatitis with steroids and who subsequently developed severe pneumopathy due to Pneumocystis carinii. One patient had a concommitant cytomegalovirus infection and both of them died. Pneumocystis carinii infections usually occur in patients a decreased immune cellular response. Steroid treatments and also alcohol may be responsible for these opportunistic infections. Alcohol may have an immunosuppressive effect by decreasing recruitment of CD4 and CD8 lymphocytes to the lungs. In conclusion, Pneumocystis carinii pneumonia is a potential complication of steroid treatments for acute alcoholic hepatitis and should be suspected in case of unexplained pulmonary infection.

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