• Chia-Tse Weng, Ming-Fei Liu, Meng-Yu Weng, Nan-Yao Lee, Ming-Chang Wang, Wei-Chieh Lin, Chih-Ying Ou, Wu-Wei Lai, Shiang-Chin Hsu, Sheau-Chiou Chao, Ta-Jung Chung, Chung-Ta Lee, Chi-Chang Shieh, Jiu-Yao Wang, and Chrong-Reen Wang.
• Rheumatology and Immunology, National Cheng Kung University Hospital and Dou-Liou Branch, Tainan, Taiwan, Republic of China.
• J Clin Rheumatol. 2013 Aug 1; 19 (5): 252-8.

BackgroundOpportunistic infection has been documented in systemic lupus erythematosus with special attention paid to Pneumocystis jirovecii because of the significant morbidity and high mortality.ObjectivesThe limited large-scale investigations covering P. jirovecii pneumonia (PCP) in systemic lupus erythematosus following biologics or immunosuppressants therapy prompted us to perform this study in southern Taiwan.MethodsA retrospective study was completed in 858 hospitalized lupus patients from January 2000 to December 2011. The definite diagnosis of PCP was made by the laboratory detection of Pneumocystis organisms together with consistent clinical and radiological manifestations of PCP. Positive polymerase chain reaction results of sputum samples were not regarded as infection in this study, unless P. jirovecii was the sole pathogen found and pulmonary manifestations resolved following antibiotics for PCP treatment alone.ResultsThe laboratory identification of Pneumocystis organisms depended on lung biopsy in 2 cases and bronchoalveolar lavage in 3 patients. Five cases, 2 women and 3 men aged 30 to 50 years (41.8 ± 8.8 years), were identified with a 0.6% incidence. None received chemoprophylactics against P. jirovecii infection. All had lupus nephritis and lymphopenia with low CD4 T-cell counts. Prior usages of higher daily prednisolone dosages and concomitant biologics or immunosuppressants were observed in all patients. Pneumocystis jirovecii pneumonia contributed to a high mortality rate (60%).ConclusionsWe report the rare occurrence but high mortality of PCP infection in this study. A consensus guideline addressing prophylactic antibiotics against Pneumocystis organisms in highest-risk lupus patients on biologics or immunosuppressants could be helpful in guiding their management.

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