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Pneumocystosis in a patient with rheumatoid arthritis on adalimumab therapy: a case-based review

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Abstract

Pneumocystis jirovecii pneumonia (PJP) is a potentially fatal type of pneumonitis, which may have devastating consequences. Typically, it occurs in immunocompromised patients, with the natural history varying depending on the presence or not of HIV infection. Staining and polymerase chain reaction (PCR) testing in induced sputum or bronchoalveolar lavage (BAL) is the cornerstone of the diagnosis, while trimethoprim-sulfamethoxazole is the treatment of choice. The etiological association of biologic agents with the occurrence of PJP is not entirely clear. Adalimumab is a fully human monoclonal anti-TNF-alpha antibody, which has been introduced relatively recently in the treatment of autoimmune inflammatory diseases, such as rheumatoid arthritis. In contrast to other biologic agents, such as Alemtuzumab or Infliximab, there are a small number of reports that support the drug's ability to trigger the occurrence of PJP. Hereby, we present a 53-year-old female patient with a medical history of rheumatoid arthritis on Adalimumab therapy, who developed PJP and we will discuss the main characteristics of PJP and the possible contribution of biologics to the occurrence of the infection.

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Authors and Affiliations

  1. Department of Internal Medicine, Hippokration General Hospital, Athens, Greece

    Dimitris C. Kounatidis, Vasileios Papadimitropoulos, Konstantinos Avramidis, Evgenia Plenga, Ioanna Tsiara, Elena Avgoustou, Natalia Vallianou & Dimitrios Vassilopoulos

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  1. Dimitris C. Kounatidis
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  2. Vasileios Papadimitropoulos
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  3. Konstantinos Avramidis
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  4. Evgenia Plenga
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  5. Ioanna Tsiara
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  6. Elena Avgoustou
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  7. Natalia Vallianou
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  8. Dimitrios Vassilopoulos
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Contributions

Conceptualization: DK, VP and DV. Methodology and Literature Research: KA, EP, IT and EA. Writing—first draft: DK and NV. Writing—review and editing: DK, NV and DV. All authors have read and have agreed with the context of this manuscript. All authors meet the criteria of ICMJE for authorship.

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Correspondence to Dimitris C. Kounatidis.

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Kounatidis, D.C., Papadimitropoulos, V., Avramidis, K. et al. Pneumocystosis in a patient with rheumatoid arthritis on adalimumab therapy: a case-based review. Rheumatol Int 44, 363–367 (2024). https://doi.org/10.1007/s00296-023-05483-3

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  • DOI: https://doi.org/10.1007/s00296-023-05483-3

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