Clinical and Radiological Features of Pneumocystis Pneumonia in Patients with Rheumatoid Arthritis, in comparison with Methotrexate Pneumonitis and Pneumocystis Pneumonia in Acquired Immunodeficiency Syndrome: A Multicenter Study
-
- Tokuda Hitoshi
- Department of Internal Medicine, Social Health Insurance Central General Hospital
-
- Sakai Fumikazu
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University
-
- Yamada Hidehiro
- Division of Rheumatology and Allergy, Department of Medicine, St. Marianna University School of Medicine
-
- Johkoh Takeshi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
-
- Imamura Akifumi
- Department of Infectious Disease, Tokyo Metropolitan Komagome Hospital
-
- Dohi Makoto
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo
-
- Hirakata Michito
- Department of Medicine, Keio University School of Medicine
-
- Yamada Takashi
- Department of Rheumatology, Tokyo Metropolitan Ohtsuka Hospital
-
- Kamatani Naoyuki
- Institute of Rheumatology, Tokyo Women's Medical University
-
- Kikuchi Yoshimi
- Department of Infectious Diseases, Research Institute, International Medical Center of Japan
-
- Sugii Shoji
- Department of Rehabilitation, National Hospital Organization Sagamihara National Hospital
-
- Takeuchi Tsutomu
- Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
-
- Tateda Kazuhiro
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine
-
- Goto Hajime
- Department of Respiratory Medicine, Kyorin University School of Medicine
Bibliographic Information
- Other Title
-
- Clinical and radiographical features of Pneumocystis pneumonia in patients with rheumatoid arthritis, in comparison with methotrexate pneumonitis and Pneumocystis pneumonia in acquired immunodeficiency syndrome: a multicenter study
Search this article
Abstract
Objective To elucidate the clinical and radiological features of Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA), compared with methotrexate (MTX) pneumonitis in RA and Pneumocystis pneumonia in acquired immunodeficiency syndrome (AIDS).<br> Subjects and Methods Retrospective analysis of 14 PCP cases in RA (RA-PCP), 10 MTX pneumonitis cases in RA (MTX-P) and 11 PCP cases in AIDS (AIDS-PCP) from 9 centers in the Kanto area in the last 6 years.<br> Results Compared with AIDS-PCP, both RA-PCP and MTX-P developed more rapidly, showing higher serum CRP and lower plasma β-D-glucan levels, and more severe oxygenation impairment. In most of the RA-PCP cases, a high dose of corticosteroid was administered as adjunctive therapy, resulting in a favorable outcome. The mortality was 14% in RA-PCP, 0% in AIDS-PCP and 0% in MTX-P cases. In RA-PCP patients the CD4 cell count showed only mild suppression, not reaching the predisposing level for PCP in HIV infection, suggesting that there are risk factors for RA-PCP other than immunosuppression. Radiologic analysis revealed some characteristic patterns of each disease. In MTX-P, diffuse homogeneous ground glass opacity (GGO) with sharp demarcation by interlobular septa (type A GGO) was found in 70%, while in AIDS-PCP diffuse, homogeneous or nonhomogeneous GGO without interlobular septal boundaries (type B GGO) was predominant (91%). In RA-PCP, type A GGO was found in 6 cases and type B GGO in 5 cases, showing the complex nature of this disease.<br> Conclusion RA-PCP differed considerably from AIDS-PCP clinically and radiologically. Clinically it occurred without severe immunosuppression, and showed characteristic aspects, with more intense inflammation and less parasite burden. Radiologically it mimicked MTX-P in some cases sharing the conspicuous CT features of MTX-P, rendering the distinction of these two disorders difficult.<br>
Journal
-
- Internal Medicine
-
Internal Medicine 47 (10), 915-923, 2008
The Japanese Society of Internal Medicine