Abstract
New cases of Pneumocystis jirovecii pneumonia (PJP) have recently been reported in patients with systemic lupus erythematosus (SLE) after rituximab therapy. Several factors may contribute to susceptibility to P. jirovecii infection in this type of patients, including the immunological characteristics of the disease, the mechanisms of rituximab action, environmental factors, and the biological characteristics of the fungus. We report two patients with SLE who developed PJP after rituximab therapy.
Similar content being viewed by others
References
Choi J, Kim ST, Craft J (2012) The pathogenesis of systemic lupus erythematosus an update. Curr Opin Immunol 24:651–657
Czuczman MS, Weaver R, Alkuzweny B, Berlfein J, Grillo-Lopez AJ (2004) Prolonged clinical and molecular remission in patients with low-grade or follicular non-Hodgkin's lymphoma treated with rituximab plus CHOP chemotherapy: 9-year follow-up. J Clin Oncol 22:4711–4716
Dass S, Vital EM, Emery P (2006) Rituximab: novel B-cell depletion therapy for the treatment of rheumatoid arthritis. Expert Opin Pharmacother 7:2559–2570
Bonilla-Abadía F, Echeverri AF, Izquierdo JH, Cañas F, Cañas CA (2012) Efficacy and safety of rituximab in the treatment of vasculitic leg ulcers associated with hepatitis C virus infection. Case report Rheumatol 2012:923897
Garcia-Carrasco M, Mendoza-Pinto C, Sandoval-Cruz M, Soto-Vega E, Beltran-Castillo A, Jimenez-Hernandez M et al (2010) Anti-CD20 therapy in patients with refractory systemic lupus erythematosus: a longitudinal analysis of 52 Hispanic patients. Lupus 19:213–219
Lund FE, Hollifield M, Schuer K, Lines JL, Randall TD, Garvy BA (2006) B cells are required for generation of protective effector and memory CD4 cells in response to Pneumocystis lung infection. J Immunol 176:6147–6154
Teichmann LL, Woenckhaus M, Vogel C, Salzberger B, Scholmerich J, Fleck M (2008) Fatal Pneumocystis pneumonia following rituximab administration for rheumatoid arthritis. Rheumatology (Oxford) 47:1256–1257
Hugle B, Solomon M, Harvey E, James A, Wadhwa A et al (2010) Pneumocystis jirovecii pneumonia following rituximab treatment in Wegener's granulomatosis. Arthritis Care Res (Hoboken) 62:1661–1664
Tsai MJ, Chou CW, Lin FC, Chang SC (2012) Pneumocystis jirovecii pneumonia in patients with systemic lupus erythematosus after rituximab therapy. Lupus 21:914–918
Su GX, Wu FQ, Wang F, Zhou ZX, Huang XL, Lu J (2012) Rituximab therapy for severe pediatric systemic lupus erythematosus. Zhongha Er Ke Za 50:697–704
Gigliotti F, Wright TW (2005) Immunopathogenesis of Pneumocystis jirovecii pneumonia. Expert Rev Mol Med 7:1–16
Ferreira S, Vasconcelos J, Marinho A, Farinha F, Almeida I et al (2009) CD4 lymphocytopenia in systemic lupus erythematosus. Acta Reumatol Port 34:200–206
Kato S, Chmielewski M, Honda H, Pecoits-Filho R, Matsuo S et al (2008) Aspects of immune dysfunction in end-stage renal disease. Clin J Am Soc Nephrol 3:1526–1533
Gea-Banacloche JC (2010) Rituximab-associated infections. Semin Hematol 47:187–198
Katsuya H, Suzumiya J, Sasaki H, Ishitsuka K, Shibata T et al (2009) Addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy has a high risk of developing interstitial pneumonia in patients with non-Hodgkin lymphoma. Leuk Lymphoma 50:1818–1823
Castagnola E, Dallorso S, Faraci M, Morreale G, Di Martino D et al (2003) Long-lasting hypogammaglobulinemia following rituximab administration for Epstein–Barr virus-related post-transplant lymphoproliferative disease preemptive therapy. J Hematother Stem Cell Res 12:9–10
Masur H, Jones TC (1979) The interaction in vitro of Pneumocystis carinii with macrophages and L-cells. J Exp Med 147:157–170
Chesnut RW, Grey HM (1982) Antigen presentation by B cells and its significance in TB interactions. Adv Immunol 39:51–94
Marcotte H, Levesque D, Delanay K, Bourgeault A, de la Durantaye R et al (1996) Pneumocystis carinii infection in transgenic B cell-deficient mice. J Infect Dis 173:1034–1037
Disclosures
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bonilla-Abadía, F., Betancurt, J.F., Pineda, J.C. et al. Pneumocystis jirovecii pneumonia in two patients with systemic lupus erythematosus after rituximab therapy. Clin Rheumatol 33, 415–418 (2014). https://doi.org/10.1007/s10067-013-2475-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-013-2475-0