Pneumocystis jirovecii Pneumonia in Patients with Inflammatory Bowel Disease–a Case Series. (12th October 2022)

• Record Type: Journal Article
• Authors: Vieujean, Sophie; Moens, Annick; Hassid, Deborah; Rothfuss, Katja; Savarino, Edoardo Vincenzo; Vavricka, Stephan R; Reenaers, Catherine; Jacobsen, Bent Ascanius; Allez, Matthieu; Ferrante, Marc; Rahier, Jean-Francois
• Is Part Of: Journal of Crohn's and colitis. Volume 17:Number 4(2023)
• Page Start: 472
• Page End: 479
• Publication Date: 2022-10-12
• Subjects: Pneumocystis jirovecii pneumonia -- inflammatory bowel disease; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjac153
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background and Aim: Pneumocystis jirovecii pneumonia [PJP] is a very rare, potentially life-threatening pulmonary fungal infection that occurs in immunocompromised individuals including patients with inflammatory bowel disease [IBD]. Our aim was to describe immunosuppressive treatment exposure as well as the outcome in IBD patients with PJP. Methods: PJP cases were retrospectively collected through the COllaborative Network For Exceptionally Rare case reports of the European Crohn's and Colitis Organisation. Clinical data were provided through a case report form. Results: In all, 18 PJP episodes were reported in 17 IBD patients [10 ulcerative colitis and seven Crohn's disease]. The median age at PJP diagnosis was 55 years (interquartile range [IQR], 40–68 years]. Two PJP [11.1%] occurred in patients on triple immunosuppression, 10 patients [55.6%] had double immunosuppressive treatment, four patients [22.2%] had monotherapy and two PJP occurred in absence of immunosuppressive treatment [one in a human immunodeficiency virus patient and one in a patient with a history of autologous stem cell transplantation]. Immunosuppressive therapies included steroids [ n = 12], thiopurines [ n = 10], infliximab [ n = 4], ciclosporin [ n = 2], methotrexate [ n = 1], and tacrolimus [ n = 1]. None of the patients diagnosed with PJP had received prophylaxis. All patients were treated by trimethoprim/sulphamethoxazole or atovaquone and an intensive care unit [ICU] stay was required in seven cases. Two patients [aged 71 and 32 years] died, and one patient had a recurrent episode 16 months after initial treatment. Evolution was favourable for the others. Conclusion: This case series reporting potentially fatal PJP highlights the need for adjusted prophylactic therapy in patients with IBD on immunosuppressive therapy.