Irish Journal of Medical Science

, Volume 176, Issue 4, pp 309–311 | Cite as

Pneumocystis carinii pneumonia in a patient on etanercept for psoriatic arthritis

  • C. Lahiff
  • O. B. Khiaron
  • N. Nolan
  • G. A. Chadwick
Case Report

Abstract

Background

Pneumocystis carinii pneumonia (PCP) is a rare form of pneumonia associated with immune-suppression. It is common in patients with AIDS and with a CD4 count of less than 200 cells/mm3. We report a case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept.

Methods

Diagnosis of PCP was made histologically using tissue obtained via transbronchial biopsy.

Results

There was a good response to standard treatment with high-dose co-trimoxazole.

Conclusion

This report highlights a recognised but previously unreported complication of etanercept.

Keywords

Pneumocystis carinii Etanercept Psoriatic arthritis Grocott’s silver stain Co-trimoxazole 

References

  1. 1.
    The National Institute of Health-University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis Pneumonia (1990) Consensus statement on the use of corticosteroids as adjunctive therapy for pneumocystis pneumonia in the acquired immunodeficiency syndrome. N Engl J Med 323:1500–1504CrossRefGoogle Scholar
  2. 2.
    Pareja JG, Garland R, Koziel H (1998) Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia. Chest 113:1215–1224PubMedCrossRefGoogle Scholar
  3. 3.
    Bakleh M, Tleyjeh I, Matteson EL, Osmon DR, Berbari EF (2005) Infectious complications of tumor necrosis factor-α antagonists. Int J Dermatol 44(6):443–448PubMedCrossRefGoogle Scholar
  4. 4.
    Weinblatt ME, Kremer JM, Bankhurst AD et al (1999) A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 340:253–259PubMedCrossRefGoogle Scholar
  5. 5.
    Olsen NJ, Stein CM (2004) New drugs for rheumatoid arthritis. N Engl J Med 350:2167–2179PubMedCrossRefGoogle Scholar
  6. 6.
    Oien KA, Black A, Hunter JA, Madhok R (1995) Pneumocystis carinii pneumonia in a patient with rheumatoid arthritis, not on immunosuppressive therapy and in the absence of human immunodeficiency virus infection. Br J Rheumatol 34:677–679PubMedCrossRefGoogle Scholar
  7. 7.
    Mori S, Imamura F, Kiyofuji C et al (2006) Pneumocystis jiroveci pneumonia in a patient with rheumatoid arthritis as a complication of treatment with infliximab, anti-tumour necrosis factor alpha neutralizing antibody. Mod Rheumatol 16(1):58–62PubMedCrossRefGoogle Scholar
  8. 8.
    Gruden JF, Huang L, Turner J et al (1997) High-resolution CT in the evaluation of clinically suspected Pneumocystis carinii pneumonia in AIDS patients with normal, equivocal, or nonspecific radiographic findings. AJR Am J Roentgenol 169:967–975PubMedGoogle Scholar
  9. 9.
    Shelhamer JH, Gill VJ, Quinn TC et al (1996) The laboratory evaluation of opportunistic pulmonary infections. Ann Intern Med 124:585–599PubMedGoogle Scholar
  10. 10.
    Saito K, Nakayamada S, Nakano K et al (2004) Detection of Pneumocystis carinii by DNA amplification in patients with connective tissue diseases: re-evaluation of clinical features of P. carinii pneumonia in rheumatic diseases. Rheumatology (Oxford) 43:479–485CrossRefGoogle Scholar
  11. 11.
    Navin R (2001) Effect of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of Pneumocystis carinii pneumonia in patients with HIV-1: a prospective study. Lancet 358:545–549PubMedCrossRefGoogle Scholar
  12. 12.
    Krebs S, Gibbons RB (1996) Low-dose methotrexate as a risk factor for Pneumocystis carinii pneumonia. Mil Med 161(1):58–60PubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2007

Authors and Affiliations

  • C. Lahiff
    • 1
  • O. B. Khiaron
    • 1
  • N. Nolan
    • 2
  • G. A. Chadwick
    • 1
  1. 1.Department of MedicineSt. Columcilles HospitalCo. DublinIreland
  2. 2.Department of PathologySt. Columcilles HospitalCo. DublinIreland

Personalised recommendations