Methotrexate-Induced Pneumocystis jirovecii Pneumonia in a Patient with Rheumatoid Arthritis: A Case Report

Ana Guiomar, João Rua and Jorge Fortuna

Department of Infectious Diseases, Coimbra Hospital and University Centre, Portugal Department of Internal Medicine, Coimbra Hospital and University Centre, Portugal

^*Correspondance to: Ana Guiomar 

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Abstract:

Pneumocystis jirovecii Pneumonia (PJP) is an emerging threat to immunocompromised patients, such as those receiving immunosuppressive therapeutics for autoimmune and inflammatory disorders. Though uncommon, PJP complicating low-dose methotrexate therapy can occur due to the risk of myelosuppression. Here we present a case of PJP in a 57-year-old man with Rheumatoid Arthritis (RA) treated with low-dose methotrexate and prednisolone for 11 years. Two years prior to hospital admission, he discontinued attendance at follow-up appointments and had been taking medications without surveillance. His symptoms consisted of fever, cough and dyspnea; with wide spread alveolar opacities and micronodules on chest radiograph, hypoxia, and severe pancytopenia. A severe folate deficiency was notable. Despite slight initial improvement, patient’s respiratory status progressively declined following immune reconstitution. The diagnosis was confirmed by bronchoalveolar lavage on the eleventh day after admission. The patient fully recovered under treatment with Trimethoprim- Sulfamethoxazole (TMP-SMX). This case highlights the importance of prompt diagnosis and treatment of PJP in rheumatoid arthritis patients undergoing methotrexate regimens. An adequate folic acid supplementation and regular blood count monitoring may minimize this risk. Primary prophylaxis could be effective, preventing PJP in selected cases; further investigation is needed to assess the efficacy and safety of prophylaxis regimens.

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Cite the Article:

Guiomar A, Rua J, Fortuna J. Methotrexate-Induced Pneumocystis jirovecii Pneumonia in a Patient with Rheumatoid Arthritis: A Case Report. Ann Clin Case Rep. 2020; 5: 1900..