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- Natsuki Shima, Ayako Kokuzawa, Keisuke Saito, Yasuyuki Kamata, Takao Nagashima, and Kojiro Sato.
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan.
- Intern. Med. 2022 Jan 15; 61 (2): 245-248.
AbstractA 68-year-old woman presenting with rheumatoid arthritis was admitted due to pancytopenia caused by methotrexate. Pneumocystis jirovecii pneumonia was diagnosed based on the abnormal shadows observed on chest computed tomography, the presence of serum β-D-glucan, and positive P. jirovecii-DNA results in a sputum analysis. Subsequently, after treatment with leucovorin and trimethoprim-sulfamethoxazole, lung consolidation was found to be aggravated, along with a rapidly increasing leukocyte count. In addition, cytomegalovirus colitis was diagnosed. Both conditions were associated with immune reconstitution inflammatory syndrome caused by recovery from leukopenia. The patient was successfully treated with intravenous methylprednisolone pulse therapy and ganciclovir.
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